Author + information
- Yang Li1,
- Cai Minzhang1,
- Ma Minghui2,
- Huang Xinmiao2,
- Liu Laixin3,
- Wang Bei4,
- Zhu Minglei5,
- Zhu Weihai2,
- Zhe Wei3,
- Guan Yumei3,
- Thitima Kongnakorn6,
- Siyang Peng6 and
- Thomas Hach7
- 1School of Public Health, Peking University, Beijing, China
- 2Health and Family Planning Commission of Xinjiang Uygur Autonomous Region, Urumqi, China
- 3Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
- 4Novartis Pharmaceuticals (China), Shanghai, China
- 5Novartis Group, Beijing, China
- 6Evidera, Hammersmith, United Kingdom
- 7Novartis International AG, Basel, Switzerland
A recent community-based disease management (CBDM) pilot study reported a 20.45% prevalence of hypertension and a 0.5% and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV) events is unknown.
A discrete event simulation was developed to evaluate the impact of CBDM on long-term CV risks among patients with hypertension in China's Xin Jiang autonomous region. The model generated pairs of identical patients; one receives CBDM and one does not (control group). Their clinical courses were simulated based on their CV risks (CHD and strokes), estimated using published risk equations. The impact of CBDM was incorporated as improvement in systolic blood pressure (SBP) based on observations from the CBDM pilot study. The simulation estimated the number of CV events over patients' lifetimes.
The discrete event simulation showed that, during a 2-year follow up, the CBDM led to an average 8.67 mmHg reduction in SBP, and reduced smoking from 11.02% to 6.35%. In the control group, the model estimated incidence rates of 289, 1765, and 304 per 100,000 individuals for lifetime CHD, stroke, and CV-related death, respectively. CBDM's impact on SBP translated into reductions of 13%, 26%, and 17% in CHD, strokes, and CV-related deaths, respectively. Taking into account CBDM's reduction of both SBP and smoking, deaths from CHD, stroke, and CV-related were reduced by 17%, 28%, and 19%, respectively.
The implementation of CBDM in China's Xin Jiang autonomous region is expected to significantly reduce incidences of CHD, strokes, and CV-related deaths.