Integrated, co-developed intervention for detection and management of cardiometabolic risk factors in older Indians (CARDIO-INDIA)

Background: Cardiovascular diseases (CVDs), comprising mainly of heart disease (angina, heart attacks and heart failure) and strokes, cause most deaths in India. CVDs are often not identified early, and older people (≥60 years) frequently have extra risk due to older age, inadequate physical activity, being overweight, having high blood pressure, or high cholesterol and diabetes. Despite the availability of proven evidence-based interventions for the early detection and effective management of CVD-related metabolic risk factors, implementation is often sub-optimal in the primary healthcare system, especially in ensuring continuity of care. Further, older people frequently have problems accessing care and taking their medications. Thus, innovative approaches to improve the detection and management need to be co-designed and evaluated with meaningful community engagement. A redesigned care delivery through strengthening mobile clinics with a clinical decision support system, assisted telemedicine, patient-facing application / in person assistance, and improved community-health system linkage can improve access to quality care and cardiovascular health outcomes among older people. Aims and objectives: We aim to co-create, implement, and evaluate a community and primary health system-based intervention (CARDIO-India programme) to improve the early detection, treatment, and management of metabolic risk factors for CVD among older people. Methods: We will use a co-creation methodology involving the community and other key stakeholders in designing CARDIO-India, considering sustainability, dissemination, and demonstrable change through iterative and co-evaluative development processes. We will evaluate the effectiveness and cost-effectiveness of CARDIO-India through a cluster randomised controlled trial (cRCT) at locations in five states across India, where the Mobile Health Unit (MHU) of HelpAge India operate. We will conduct mixed-methods research to investigate the implementation and operationalization of CARDIO-India, focusing on adaptation to local contextual factors, people s experience in recruitment and engagement, and their views about risk factor detection and management. Finally, we will develop a toolkit to enable the programme s widespread adoption and adaptation for easy access and delivery. Timelines for delivery: CARDIO-India will be delivered over five years. Anticipated impact and dissemination: This project can seminally impact the healthcare of older people in several ways. The findings of this project will have a significant impact, given the push by the government of India to integrate telemedicine capabilities into existing mobile medical units (MMU) under the National Health Mission (NHM) across India. It will also inform better implementation of the National Programme for Health Care of the Elderly (NPHCE) and the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD). It has the potential to create a new model of healthcare that can reach the unreached. It will develop a redesigned health care package for control of metabolic risk factors for CVD among older individuals. Potential to improve quality of life and improve health-adjusted life years. Serve as a potential model for scale-up both in India and other countries. For dissemination, we will create policy briefs, conduct sensitization workshops for policymakers (members of parliament and state assemblies, ministry of health officials and others), and conduct media dissemination workshops.