Abstract:
Background
The majority of global cardiovascular disease (CVD) burden falls on people living in low-
and middle-income countries (LMICs). In order to reduce preventable CVD mortality and
morbidity, LMIC health systems and health care providers need to improve the delivery and
quality of CVD care.
Objectives
As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality
improvement, we reviewed and summarized currently available evidence on interventions
to improve quality of clinic-based CVD prevention and management in LMICs.
Methods
We conducted a narrative review of published comparative clinical trials that evaluated effi-
cacy or effectiveness of clinic-based CVD prevention and management quality improve-
ment interventions in LMICs. Conditions selected
a priori
included hypertension, diabetes,
hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive
heart failure. MEDLINE and EMBASE electronic databases were systematically searched.
Studies were categorized as occurring at the system or patient/provider level and as treating
the acute or chronic phase of CVD.Results
From 847 articles identified in the electronic search, 49 met full inclusion criteria and were
selected for review. Selected studies were performed in 19 different LMICs. There were 10
studies of system level quality improvement interventions, 38 studies of patient/provider
interventions, and one study that fit both criteria. At the patient/provider level, regardless of
the specific intervention, intensified, team-based care generally led to improved medication
adherence and hypertension control. At the system level, studies provided evidence that
introduction of universal health insurance coverage improved hypertension and diabetes
control. Studies of system and patient/provider level acute coronary syndrome quality
improvement interventions yielded inconclusive results. The duration of most studies was
less than 12 months.
Conclusions
The results of this review suggest that CVD care quality improvement can be successfully
implemented in LMICs. Most studies focused on chronic CVD conditions; more acute CVD
care quality improvement studies are needed. Longer term interventions and follow-up will
be needed in order to assess the sustainability of quality improvement efforts in LMICs
