Assessing a multicomponent quality improvement strategy for chronic care of cardiovascular diseases in India: The C-QIP randomized feasibility trial

Chronic cardiovascular diseases (CVD) care in India often falls short of optimal standards. Researchers evaluated the practicality, patient acceptance, and early impact of a comprehensive, collaborative quality improvement (C-QIP) approach for patients with CVD in outpatient clinics across public and private hospitals. The study involved 410 adults with ischemic heart disease, ischemic stroke, or heart failure, randomly assigned to either the C-QIP intervention or standard care.

The C-QIP program incorporated electronic decision support for healthcare providers, non-physician care coordination, patient education, text-message reminders, and feedback from audits. The primary goals were to assess feasibility, fidelity, adoption, and patient satisfaction, while secondary objectives focused on guideline-adherent medical therapy, medication adherence, care processes, and risk factors.

After a median follow-up of 15 months, 93.2% of C-QIP participants and 91.7% of usual care patients remained in the study. The intervention successfully enhanced guideline-directed medical therapy (GDMT) for ischemic heart disease (58.3% vs. 32.4%; relative risk 1.45) and ischemic stroke (76.7% vs. 31.8%; relative risk 2.41), but not for heart failure.

Additionally, patients in the C-QIP group reported higher adherence to medications (90.9% vs. 82.3%; relative risk 1.08), diet (91.9% vs. 82.3%; relative risk 1.07), and physical activity (91.4% vs. 70.4%; relative risk 1.23). However, the study's limitations include its feasibility design, individual randomization within shared clinics, and insufficient power for clinical outcomes and subgroup analysis.

The findings suggest that the C-QIP approach is feasible and acceptable, leading to improved care processes for chronic CVD patients in India. Further large-scale, confirmatory trials are required to determine if such quality improvement strategies can effectively reduce cardiovascular morbidity and mortality. The trial was registered as NCT05196659; CTRI/2022/04/041847.