C. Raina Elley, MBChB, PhD; Ngaire Kerse, MBChB, PhD
In older adults, does the Cardiovascular Health Awareness Program (CHAP) reduce morbidity from cardiovascular (CV) disease?
Cluster-randomized controlled trial. Current Controlled Trials ISRCTN50550004.
1 year after CHAP was implemented.
39 communities with populations of 10 000 to 60 000 in Ontario, Canada.
Community-dwelling adults ≥ 65 years of age (mean age 75 y, 57% women, mean 3606 per community) were eligible for outcome assessment. All residents of CHAP communities could take part in the intervention.
CHAP (20 communities) or control (19 communities). Family physicians and pharmacies in CHAP communities were encouraged to invite patients ≥ 65 years of age to participate in CHAP, which comprised 10 weeks of community, pharmacy-based, 3-hour sessions offering blood pressure and CV risk factor assessment and standardized education. Blood pressure and risk factor data were shared with residents, physicians, and pharmacists. Residents of all communities received usual health promotion and care services.
Hospitalization for acute myocardial infarction, stroke, and congestive heart failure in residents ≥ 65 years of age. Secondary outcomes included mortality during the above hospitalizations, all-cause mortality, and newly prescribed antihypertensive treatment. Outcomes were collected from population-based administrative health data at 12 months after program implementation and were compared with event rates in the year before implementation.
100% of communities (intention-to-treat analysis).
All intervention communities successfully implemented CHAP, with 89% of pharmacies participating and 15 889 residents having CV assessments during 1265 sessions. The main results are in the Table.
In older adults, the Cardiovascular Health Awareness Program reduced cardiovascular hospitalizations but not all-cause mortality.
Cardiovascular Health Awareness Program (CHAP) vs control in residents ≥ 65 years of age‡
‡Abbreviations defined in Glossary. RRR, RBI, and CI calculated from data in article. Change in rate compares the 1-year post-CHAP period with the 1-year pre-CHAP period, except for antihypertensive treatment, which compares the 1-year period during which CHAP was implemented with the 1-year pre-CHAP period. Negative numbers indicate decreases in event from pre- to postintervention periods.
§Hospital admissions for acute myocardial infarction (RRR 13%, CI 3 to 21), congestive heart failure (RRR 10%, CI 1 to 19), and stroke (RRR 1%, CI −12 to 12).
¶Not statistically significant.
Elley CR, Kerse N. The Cardiovascular Health Awareness Program reduced CV hospitalizations but not mortality in older adults. Ann Intern Med. ;154:JC6–3. doi: 10.7326/0003-4819-154-12-201106210-02003
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Published: Ann Intern Med. 2011;154(12):JC6-3.
Cardiology, Geriatric Medicine, Hospital Medicine, Prevention/Screening.
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