Zhang Xingyi, Wang Siming, Zhou Xingyu, Tang Yajie, Xing Liying, Ma Shaoning, Xu Yan, Wu Chaoqun, Cui Jianlan, Yang Yang, Lin Chunying, Wu Yi, Zhang Haibo, Fan Lei, Xu Chunxiao, Li Xi
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China.
BMJ. 2025 May 27;389:e082765. doi: 10.1136/bmj-2024-082765.
To assess the effectiveness of a village doctor-led mobile health intervention on cardiovascular risk reduction among residents in rural China.
Cluster randomised controlled trial.
127 villages from five provinces and autonomous regions in China.
4533 participants from 127 villages: 2297 (64 villages) were randomly assigned to the intervention group and 2236 (63 villages) to the control group. Participants were aged ≥35 years, had no established atherosclerotic cardiovascular disease (ASCVD) but a predicted 10 year risk of ≥10%, had contracted a family doctor service with the local village doctor, and owned a smart phone.
In addition to usual clinical care and basic public health services provided for the control group, the intervention led by village doctors included five components: assessing risk factors to identify individualised intervention targets, setting gradual goals based on doctor-participant communication, providing targeted short videos on health education, conducting health monitoring with periodic feedback, and providing motivation to reduce risk based on gamification.
Mean change in predicted 10 year risk of ASCVD from baseline to 12 months.
Enrolment took place between March 2023 and May 2023. During the 12 month follow-up (completion rate 99.4%), the 10 year risk of ASCVD decreased from 18.0% to 11.7% in the intervention group and from 17.8% to 13.6% in the control group (absolute difference -1.88% (95% confidence interval (CI) -2.57% to -1.19%; P<0.001). Compared with the control group, the intervention group showed larger reductions in lifetime ASCVD risk (-15.9% -11.0%; difference -4.59%; P<0.001), systolic blood pressure (-23.2 mm Hg -15.2 mm Hg; difference -7.64 mm Hg; P<0.001), diastolic blood pressure (-10.9 mm Hg -6.9 mm Hg; difference: -3.59 mm Hg; P<0.001), fasting blood glucose (-0.9 mmol/L -0.5 mmol/L; difference -0.30 mmol/L; P=0.008), proportion of daily smokers (-3.1% -0.6%; odds ratio 0.60, 95% CI 0.43 to 0.84; P=0.003), and insufficient physical activity (-3.0% 1.3%; odds ratio 0.63, 0.42 to 0.95; P=0.03). No significant differences were observed for change in non-high density lipoprotein cholesterol or proportion of participants with obesity.
The village doctor-led mobile health intervention was effective at reducing cardiovascular risk and improving control of behavioural and metabolic risk factors. This feasible approach could be scaled up in rural China and other under-resourced settings to improve health management based on the local primary healthcare system.
ClinicalTrials.gov NCT05645640.
评估由乡村医生主导的移动健康干预措施对降低中国农村居民心血管疾病风险的有效性。
整群随机对照试验。
中国五个省和自治区的127个村庄。
来自127个村庄的4533名参与者：2297名（64个村庄）被随机分配到干预组，2236名（63个村庄）被分配到对照组。参与者年龄≥35岁，没有已确诊的动脉粥样硬化性心血管疾病（ASCVD）但预测10年风险≥10%，已与当地乡村医生签约家庭医生服务，且拥有智能手机。
除了为对照组提供的常规临床护理和基本公共卫生服务外，由乡村医生主导的干预包括五个部分：评估风险因素以确定个体化干预目标，基于医生与参与者的沟通设定渐进目标，提供有针对性的健康教育短视频，进行健康监测并定期反馈，以及基于游戏化提供降低风险的激励措施。
从基线到12个月时ASCVD预测10年风险的平均变化。
招募于2023年3月至2023年5月进行。在12个月的随访期间（完成率99.4%），干预组的ASCVD 10年风险从18.0%降至11.7%，对照组从17.8%降至13.6%（绝对差异-1.88%（95%置信区间（CI）-2.57%至-1.19%；P<0.001）。与对照组相比，干预组在终身ASCVD风险降低方面更大（-15.9% -11.0%；差异-4.59%；P<0.001），收缩压（-23.2 mmHg -15.2 mmHg；差异-7.64 mmHg；P<0.001），舒张压（-10.9 mmHg -6.9 mmHg；差异：-3.59 mmHg；P<0.001），空腹血糖（-0.9 mmol/L -0.5 mmol/L；差异-0.30 mmol/L；P=0.008），每日吸烟者比例（-3.1% -0.6%；比值比0.60，95%CI 0.43至0.84；P=0.003），以及身体活动不足（-3.0% 1.3%；比值比0.63，0.42至0.95；P=0.03）。在非高密度脂蛋白胆固醇变化或肥胖参与者比例方面未观察到显著差异。
由乡村医生主导的移动健康干预在降低心血管疾病风险以及改善行为和代谢风险因素控制方面是有效的。这种可行的方法可以在中国农村和其他资源匮乏地区扩大规模，以基于当地基层医疗系统改善健康管理。
ClinicalTrials.gov NCT05645640。
