20th European Meeting on Hypertension

Monday, 21st June – A community outreach program aimed at improving cardiovascular (CV) health awareness is an effective, feasible approach to CV management and risk reduction, according to results from the Community Cardiovascular Health Awareness Program (C-CHAP).  Lisa Dolovich, BScPhm, MSc, PharmD, McMaster University, Hamilton, Ontario, Canada, presented results from this Canadian community cluster, randomized, controlled trial at the European Society of Hypertension Annual Meeting in Oslo, Norway.

C-CHAP was designed to evaluate the effectiveness of a CV health awareness program in reducing the incidence of stroke and CV morbidity at the community level (population 10,000 to 60,000). Randomization included 39 communities with participating family physicians and pharmacists, of which 20 received intervention.  C-CHAP intervention consisted of community-wide CHAP session promotion, trained peer volunteers who monitored blood pressure (BP) measurements (via an automated device) and administered standardized CVD and stroke risk assessments, and local educational resources targeting specific modifiable risk factors provided to all participants. BP and risk assessment data were entered into a centralized, web-based data management system and was disclosed to clinicians and participants. Community health nurses and pharmacists were made available to those participants who had high BP readings and follow-up was arranged for those participants who were deemed high-risk. CHAP education sessions were held on a weekly basis for all participants.

In the fall of 2006, CHAP was successfully launched in 20 randomly selected communities with 214 active physician participants and 129 active pharmacy participants.  Assessments were performed on 15,889 unique participants and 1265 sessions took place (~25% of older adults attended at least one session).  Pre- and post-CHAP data were documented and analyzed (defined as 01/09/2005-31/08/2006 and 01/09/2007-31/08/2008, respectively).

The primary composite end-point was the rate of hospital admissions for acute myocardial infarction (AMI), congestive heart failure (CHF), and stroke among community residents aged ≥65 years. A significant decrease in hospital admissions for the composite endpoint was observed in the CHAP group compared with control (RR, 0.91; 95% CI, 0.86 to 0.97; p<0.01).  The CHAP communities demonstrated a 6% decrease in hospital admissions during the aforementioned time period, while the control communities demonstrated a 3% increase. The rate of hospital admissions for AMI and CHF also favored the CHAP approach compared with control (p<0.01 for AMI and p=0.03 for CHF). CHAP resulted in lower rates of in-hospital death (p=0.06) and fewer instances of hypertension therapy initiation (p=0.02).

This innovative approach to CV risk reduction resulted in significant decreases in CV morbidity.  It appeared to be well-received, as there was a high rate of participation on the part of the health professionals, the peer volunteers, and the community participants.  The CHAP study demonstrated that this is an effective approach to CV management and risk reduction at the community level.  More information regarding this program can be found at www.CHAPprogram.ca.