Guyana CVD

Cardiovascular disease (CVD) is one of the most common causes of death in Guyana. Risk factors such as smoking, diabetes and hypertension need to be screened and managed early. Due to a lack of physicians in Guyana, clinicians have little time to screen, identify and fully address CVD and its risk factors. The WHO framework for task shifting and redistributing specific tasks to non-physician health workers (NPHWs) provides a potential solution to this problem.

Objectives:

1) To develop, implement and evaluate a programme for screening and managing CVD and its risk factors using up-to-date evidence and guideline recommendations in Guyana.
2) To evaluate the feasibility of using NPHWs as the primary point of contact.
3) To assess the feasibility of performing larger-scale epidemiological and health intervention studies in Guyana.

Primary outcomes:

• Qualitative feedback from participants, NPHWs, and supervising physicians.
• Participant recruitment and retention into the program as assessed by the rate of consent, and completion of follow-up visits at 3, 6 and 12 months.
• Adherence to intervention as assessed by the participant?s continued use of the recommended intervention for CVD and its risk factors.

Secondary outcomes:

• Change in LDL/HDL, triglyceride and total cholesterol from baseline to 12 months.
• Change in BP from baseline to 12 months.
• Proportion of participants with well-controlled blood pressure at baseline, 3, 6 and 12 months (SBP<140 mmHg in non-diabetic individuals, SBP<130 mmHg in diabetic individuals).
• Changes in Cholesterol Modifiable Risk Score and non-lab INTERHEART Risk Score at baseline, 6 months and 12 months.
• Medication adherence measures at 6 and 12 months.
• Change in random PG from baseline to 12 months.
• Change in fasting PG for diabetic individuals from baseline to 12 months.
• Change in waist-to-hip ratio from baseline to 12 months.
• Change in height, weight and body-mass index from baseline to 12 months.
• Proportion of participants who smoke at baseline, 3, 6 and 12 months.
• Proportion of participants who are exposed to secondhand smoke at baseline, 3, 6 and 12 months.
• Proportion of participants with self-reported 30-minutes of moderate level of physical activity per day, at least 5 times per week at baseline, 3, 6 and 12 months.
• Proportion of participants with self-reported heart healthy diet at baseline, 3, 6 and 12 months.
• Change in FRS from baseline to 12 months.
• Clinical events (CVD development, hospitalisation and deaths) at 3, 6 and 12 months.