title: Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP).
abstract: OBJECTIVE
  To evaluate the effectiveness of the community based Cardiovascular Health Awareness Program (CHAP) on morbidity from cardiovascular disease.
  
  
  METHODS
  Community cluster randomised trial.
  
  
  METHODS
  39 mid-sized communities in Ontario, Canada, stratified by location and population size.
  
  
  METHODS
  Community dwelling residents aged 65 years or over, family physicians, pharmacists, volunteers, community nurses, and local lead organisations.
  
  
  METHODS
  Communities were randomised to receive CHAP (n = 20) or no intervention (n = 19). In CHAP communities, residents aged 65 or over were invited to attend volunteer run cardiovascular risk assessment and education sessions held in community based pharmacies over a 10 week period; automated blood pressure readings and self reported risk factor data were collected and shared with participants and their family physicians and pharmacists.
  
  
  METHODS
  Composite of hospital admissions for acute myocardial infarction, stroke, and congestive heart failure among all community residents aged 65 and over in the year before compared with the year after implementation of CHAP.
  
  
  RESULTS
  All 20 intervention communities successfully implemented CHAP. A total of 1265 three hour long sessions were held in 129/145 (89%) pharmacies during the 10 week programme. 15,889 unique participants had a total of 27,358 cardiovascular assessments with the assistance of 577 peer volunteers. After adjustment for hospital admission rates in the year before the intervention, CHAP was associated with a 9% relative reduction in the composite end point (rate ratio 0.91, 95% confidence interval 0.86 to 0.97; P = 0.002) or 3.02 fewer annual hospital admissions for cardiovascular disease per 1000 people aged 65 and over. Statistically significant reductions favouring the intervention communities were seen in hospital admissions for acute myocardial infarction (rate ratio 0.87, 0.79 to 0.97; P = 0.008) and congestive heart failure (0.90, 0.81 to 0.99; P = 0.029) but not for stroke (0.99, 0.88 to 1.12; P = 0.89).
  
  
  CONCLUSIONS
  A collaborative, multi-pronged, community based health promotion and prevention programme targeted at older adults can reduce cardiovascular morbidity at the population level. Trial registration Current controlled trials ISRCTN50550004.
authors.affiliation: Department of Family Practice, University of British Columbia, 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3. Janusz.kaczorowski@familymed.ubc.ca
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chambers
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.forename: Tina
authors.initials: T
authors.lastname: Karwalajtys
authors.forename: Tracy
authors.initials: T
authors.lastname: Gierman
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
authors.forename: Beatrice
authors.initials: B
authors.lastname: McDonough
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Levitt
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.forename: Stephanie
authors.initials: S
authors.lastname: Laryea
authors.forename: Megan Ann
authors.initials: MA
authors.lastname: Carter
authors.forename: Dana
authors.initials: D
authors.lastname: Cross
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Sabaldt
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D016000:Cluster Analysis; D003153:Community Health Services / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D015397:Program Evaluation; D012017:Referral and Consultation