In the Journals

Community health worker-based intervention improves cardiometabolic risk

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February 9, 2016

Patients hospitalized with acute coronary syndrome randomly assigned to an intervention with community health workers saw improved adherence to medication and diet, increased physical activity and reductions in cardiometabolic risk markers, according to recent study findings.

“Despite the overall high level of adherence, community health worker interventions showed improved adherence to evidence-based drugs,” Denis Xavier, MD, MBBS, MSc, vice dean, professor and head of the department of pharmacology at St. John’s Medical College, Bangalore, India, and colleagues wrote. “This result is probably driven by the key intervention in the trial, which was for the community health worker to identify barriers related to drug adherence and to help the patient find acceptable strategies to overcome them. Barriers to drug adherence included lack of knowledge, cost of drugs, side effects and insufficient family support.”

Denis Xavier

Denis Xavier

Xavier and colleagues analyzed data from 806 patients with acute coronary syndrome (ACS) from 14 hospitals in 14 cities across India (83% men; mean age, 57 years; 54% with ST-elevation myocardial infarction) participating in the Secondary Prevention of Coronary Events After Discharge From Hospital (SPREAD) study. Between August 2011 and June 2012, researchers randomly assigned patients to a community health worker-based intervention group (n = 405) or a standard care group (n = 401) 1 or 2 days before hospital discharge. Intervention included four in-hospital visits at 1, 5, 7 and 12 months, and two home visits at 3 and 9 months with community health workers. Visits were unstructured 45- to 60-minute discussions that included visual methods and patient diaries designed to reinforce healthy lifestyle habits and drugs adherence.

Researchers measured adherence to proven secondary prevention drugs at 1 year (antiplatelet drugs, beta-blockers, angiotensin-converting enzyme [ACE] inhibitors or angiotensin receptor blockers, and statins), using a composite medication adherence scale. Secondary outcomes included differences in lifestyle factors and clinical risk markers, including blood pressure, body weight, BMI, heart rate and lipid profiles.

Analysis at 1 year included 375 patients in each group (40 patients died; 15 discontinued study or were lost to follow-up). Within the cohort, 98% were prescribed any antiplatelet drug, 79% prescribed dual antiplatelet drugs, 69% prescribed beta-blockers, 69% prescribed ACE inhibitors and angiotensin receptor blockers, and 95% prescribed statins.

Researchers found that significantly more patients in the intervention group were adherent to drug treatments and consumed more than 80% of the prescribed four classes of secondary drugs (97% vs. 92%; OR = 2.62; 95% CI, 1.32-5.19)

Researchers also noted significantly greater adherence for ACE inhibitors and angiotensin receptor blockers (97% vs. 93%; P = .036) and statins (97% vs. 93%; P = .011). There were no significant between-group differences for antiplatelet drugs or beta-blockers.

Among patients who reported smoking at hospital admission (n = 267), a significantly greater proportion in the intervention group reported abstaining from smoking at 1 year vs. controls (85% vs. 52%; OR = 5.46; 95% CI, 3.03-9.86). More patients in the intervention group also reported adhering to prescribed physical activity, consuming a healthy diet and abstaining from alcohol.

At 1 year, patients in the intervention group had lower mean systolic BP vs. controls (124.4 mm Hg vs. 128 mm Hg; P = .002), as well as body weight (65 kg vs. 66.5 kg; P < .0001) and BMI (24.4 kg/m² vs. 25 kg/m²; P < .0001). There were no significant between-group differences for diastolic BP or heart rate.

“The SPREAD trial demonstrated that community health workers with modest education and training could add value to the present health care system in greatly improving secondary prevention after a heart attack,” Xavier told Endocrine Today. “Trained community health workers can therefore be integrated in to the present health care system to improve outcomes after heart attack.” – by Regina Schaffer

For more information:

Denis Xavier, MD, MBBS, MSc, can be reach at St. John’s Medical College, Sarjapur Road, Opp BDA Complex, Bengaluru, Karnataka 560034, India; email: denis@sjri.res.in.

Disclosure: The researchers report no relevant financial disclosures.