Heart Attack Care in India
This stepped wedge, cluster randomized trial was the largest cardiovascular randomized trial in India and demonstrated improvements in process measures among 21,374 patients with heart attacks who were recruited from 63 hospitals in Kerala, India, from 2014 to 2016. The trial also reported health-related quality of life and individual- and household-level costs among heart attack survivors and served as a training hub/model for 7 Fogarty-funded Northwestern global health fellows.
Funding
National Heart, Lung, and Blood Institute (K99/R00HL107749), with support from the Cardiological Society of India–Kerala Chapter, Centre for Chronic Disease Control, Northwestern University Global Health Initiative, and Northwestern University Clinical and Translational Science Institute (UL1TR001422).
Northwestern Faculty and Staff
PI Mark Huffman, MD, MPH; Abigail Baldridge, MS; Donald M Lloyd-Jones, MD, ScM; Lihui Zhao, PhD
Partners
Dorairaj Prabhakaran, Centre for Chronic Disease Control/Public Health Foundation of India; P.P. Mohanan, Westfort Hi-Tech Hospital, Ltd.; Cardiological Society of India – Kerala Chapter
Fogarty-funded fellows
Amisha Patel (pre-hospital acute coronary syndrome system of care), Smitha Sarma (tobacco cessation pharmacoepidemiology), Ehete Bahiru (acute coronary syndrome care in Kenya), Anubha Agarwal (heart failure quality improvement), Sang Gune Kyle Yoo (health management evaluation), Nikhil Venkathesmurthy (hypertension system-level intervention and implementation research), Kavita Singh (secondary prevention implementation research)
Related Publications
- Huffman MD, Mohanan PP, Devarajan R, Baldridge AS, Kondal D, Zhao L, Ali M, Lloyd-Jones DM, Prabhakaran D. Acute coronary syndrome quality improvement in Kerala (ACS QUIK): Rationale and design for a cluster-randomized stepped-wedge trial. Am Heart J. 2017 Mar;185:154-160. doi: 10.1016/j.ahj.2016.10.026. Epub 2016 Dec 21. PubMed PMID: 28267469; PubMed Central PMCID: PMC5341136.
- Huffman MD, Mohanan PP, Devarajan R, Baldridge AS, Kondal D, Zhao L, Ali M, Krishnan MN, Natesan S, Gopinath R, Viswanathan S, Stigi J, Joseph J, Chozhakkat S, Lloyd-Jones DM, Prabhakaran D; Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) Investigators. Effect of a quality improvement intervention on clinical outcomes in patients in India with acute myocardial infarction: The ACS QUIK randomized clinical trial. JAMA. 2018 Feb 13;319(6):567-578. doi: 10.1001/jama.2017.21906. PubMed PMID: 29450524; PubMed Central PMCID: PMC5838631.
- Singh K, Devarajan R, Mohanan PP, Baldridge AS, Kondal D, Victorson DE, Karmali KN, Zhao L, Lloyd-Jones DM, Prabhakaran D, Goenka S, Huffman MD; ACS QUIK Investigators. Implementation and acceptability of a heart attack quality improvement intervention in India: a mixed methods analysis of the ACS QUIK trial. Implement Sci. 2019 Feb 6;14(1):12. doi: 10.1186/s13012-019-0857-7. PubMed PMID: 30728053; PubMed Central PMCID: PMC6364470.
- Huffman MD, Mohanan PP, Devarajan R, Baldridge AS, Kondal D, Zhao L, Ali M, Spertus JA, Chan PS, Natesan S, Abdullakutty J, Krishnan MN, Tp A, Renga S, Punnoose E, Unni G, Prabhakaran D, Lloyd-Jones DM; ACS QUIK Investigators. Health-related quality of life at 30 days among Indian patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2019 Feb;12(2):e004980. doi: 10.1161/CIRCOUTCOMES.118.004980. PubMed PMID: 30755027; PubMed Central PMCID: PMC6375309.
- Patel A, Prabhakaran D, Berendsen M, Mohanan PP, Huffman MD. Pre-hospital policies for the care of patients with acute coronary syndromes in India: A policy document analysis. Indian Heart J. 2017 Apr;69 Suppl 1:S12-S19. doi: 10.1016/j.ihj.2016.06.012. Epub 2016 Jun 29. PubMed PMID: 28400033; PubMed Central PMCID: PMC5388021.
- Patel A, Mohanan PP, Prabhakaran D, Huffman MD. Pre-hospital acute coronary syndrome care in Kerala, India: A qualitative analysis. Indian Heart J. 2017 Jan-Feb;69(1):93-100. doi: 10.1016/j.ihj.2016.07.011. Epub 2016 Jul 19. PubMed PMID: 28228314; PubMed Central PMCID: PMC5319123.
- Bahiru E, Temu T, Gitura B, Farquhar C, Huffman MD, Bukachi F. Presentation, management and outcomes of acute coronary syndrome: a registry study from Kenyatta National Hospital in Nairobi, Kenya. Cardiovasc J Afr. 2018 Jul/Aug 23;29(4):225-230. doi: 10.5830/CVJA-2018-017. Epub 2018 May 24. PubMed PMID: 29878033.
- Bahiru E, Temu T, Mwanga J, Ndede K, Vusha S, Gitura B, Farquhar C, Bukachi F, Huffman MD. Facilitators, context of and barriers to acute coronary syndrome care at Kenyatta National Hospital, Nairobi, Kenya: a qualitative analysis. Cardiovasc J Afr. 2018 May/Jun 23;29(3):177-182. doi: 10.5830/CVJA-2018-013. Epub 2018 Apr 20. PubMed PMID: 29750227; PubMed Central PMCID: PMC6107733.
- Sarma S, Harikrishnan S, Baldridge AS, Devarajan R, Mehta A, Selvaraj S, Ali MK, Mohanan PP, Prabhakaran D, Huffman MD. Availability, sales, and affordability of tobacco cessation medicines in Kerala, India. Circ Cardiovasc Qual Outcomes. 2017 Nov;10(11). pii: e004108. doi: 10.1161/CIRCOUTCOMES.117.004108. PubMed PMID: 29150536; PubMed Central PMCID: PMC5726807.
- Bhaumik SS, Placek C, Kochumoni R, Lekha TR, Prabhakaran D, Hitsman B, Huffman MD, Harikrishnan S, Goenka S. Tobacco cessation among acute coronary syndrome patients in Kerala, India: Patient and provider perspectives. Qual Health Res. 2018 Dec 14:1049732318817047. doi: 10.1177/1049732318817047. [Epub ahead of print] PubMed PMID: 30547727.
- Agarwal A, Bahiru E, Yoo SGK, Berendsen MA, Harikrishnan S, Hernandez AF, Prabhakaran D, Huffman MD. Hospital-based quality improvement interventions for patients with heart failure: a systematic review. Heart. 2019 Mar;105(6):431-438. doi: 10.1136/heartjnl-2018-314129. Epub 2019 Jan 30. Review. PubMed PMID: 30700515.