Abstract MP71: Undetected Disease and Low Medication Adherence are Major Determinants of Poor Cardiovascular Risk Factor Control in Rural India

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Background: Cardiovascular disease is the leading cause of mortality in India. Since it is largely driven by risk factors such as hypertension, diabetes and smoking it is important to study diagnosis, treatment and control patterns for these conditions, and identify areas for improvement.

Methods: Project SEHAT (ClinicalTrials.gov number, NCT02115711) is a cluster RCT with a long term goal of improving the control of cardiovascular risk factors in a rural community in West Bengal, India. For the baseline data, 3575 adults, between the ages of 35 and 70, were screened for hypertension, diabetes and smoking. For hypertension and diabetes, an elevated reading was confirmed on a repeat visit.

Results: Risk factors were common, with hypertension, diabetes and smoking evident in 18.3% (654 of 3575), 9.0% (321 of 3575) and 15.1% (540 of 3575) of adults, respectively. Overall, 34.5% (1233 of 3575) of adults had at least one risk factor. There was a huge burden of undetected disease, with only 45.2% (296 of 654) of hypertensives and 59.8% (192 of 321) of diabetics previously aware of their disease. Linkage to care was high with 72.0% (213 of 296) of previously diagnosed hypertensives and 86.0% (165 of 192) of previously diagnosed diabetics on treatment. Control rates were, however, low with 8.2% (54 of 654) of hypertensives controlled (BP <140/90 mmHg) and 13.7% (44 of 321) of diabetics controlled (fasting blood sugar <126 mg/dl). This may be partly explained by a low medication adherence rate, with the adherence (medium and high) being 35.5% (76 of 213) in hypertensives and 20.6% (34 of 165) in diabetics, as measured by the Morisky Medication Adherence Scale-8.

Conclusions: In our population in rural India, 1 in 3 adults have a major cardiovascular risk factor, with abysmal control rates. Barriers to risk factor control primarily exist at the points of diagnosis and medication adherence. Over the next 2 years, a community health worker led intervention, with an aim to improve the control of hypertension, diabetes and smoking will be tested in this cohort.

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