Exploring new models for cardiovascular risk reduction: The Heart Outcomes Prevention and Evaluation 4 (HOPE 4) Canada Pilot Study

Abstract: Background There is a gap between evidence and practice in the management of cardiovascular (CV) risk. Previous research indicated benefits from community-based, multi-faceted interventions to screen, diagnose and manage CV risk in people with hypertension. Methods The HOPE 4 Canada pilot study was a quasi-experimental pre-post interventional study, involving one community each in Hamilton ON and Surrey BC. Individuals ≥50 years old with newly diagnosed or poorly controlled hypertension were included. Intervention comprised: (1) simplified diagnostic/treatment algorithms implemented by community health workers (CHW) (firefighters in BC and community health-workers in ON) guided by decision support and counselling software; (2) recommendations for evidence-based CV medications and lifestyle modifications; and (3) support from family/friends to promote healthy behaviours. The intervention was developed as part of the international HOPE 4 trial and adapted to the Canadian context. The primary outcome was the change in Framingham Risk Score (FRS) 10-year CVD risk estimate between baseline and 6 months. Results Between 2016 and 2017, 193 participants were screened, with 37 enrolled in Surrey, and 19 in Hamilton. Mean age was 69 years (SD 11), with 54% female, 27% diabetic, and 73% with a history of hypertension. 82% follow-up was obtained at six months. Compared to baseline, there were significant improvements in the FRS 10-year risk estimate (30.6% vs. 24.7%, p Conclusion A comprehensive approach to health care delivery, using a community-based intervention with CHW, supported by mobile-health technologies, have the potential to significantly reduce CV risk, but further evaluation is warranted.