On April 19, at the ten-year review of the early screening and comprehensive intervention project for high-risk groups of cardiovascular diseases held by the National Center for Cardiovascular Diseases, Hu Shengshou, director of the National Center for Cardiovascular Diseases, president of Fuwai Hospital of the Chinese Academy of Medical Sciences, and person in charge of the project, introduced that the control rate of the "three highs" (hypertension, hyperlipidemia, and hyperglycemia) of high-risk groups screened by the project has increased by 3~5 times, and the risk of cardiovascular diseases such as acute myocardial infarction and stroke has decreased by more than 20%.
In 2014, the Ministry of Finance and the National Health and Family Planning Commission set up an early screening and comprehensive intervention program for high-risk groups of cardiovascular diseases in local health and family planning projects transferred by the central government. The National Center for Cardiovascular Diseases, as a national technical guidance institution, took over this important task and sounded the clarion call to shift the main battlefield of cardiovascular disease prevention and treatment from hospitals to communities.
Ten years of persistence has brought a big step forward in the prevention and control of cardiovascular diseases.
Mapping the risk of cardiovascular disease
Walk past one and mark a red dot on the map. In 2014, 20 project sites in 4 provinces were scattered across 20 projects, and now they are dotted with red dots in 31 provinces, 292 prefecture-level cities, 385 counties, and 54,000 villages (communities) on the mainland.
Li Xi, deputy director of the Department of Preventive Medicine at the National Center for Cardiovascular Diseases, said: "Along this trajectory, the project team has screened more than 5.27 million residents, identified 1.49 million high-risk subjects for cardiovascular disease, and carried out 4.7 million annual intervention follow-up visits for high-risk subjects, with a maximum follow-up time of 9 years and an average follow-up period of 5 years. The project has built the world's largest prospective natural population cohort and a cohort of high-risk subjects for cardiovascular disease, and also found out the 'family background' for cardiovascular disease in mainland China and outlined the 'portrait' of cardiovascular disease risk. "Portraits" are divided into two levels: one is the regional "portrait", and the other is the personal "portrait". Li Xi took the reporter to the disease prevention and health education exhibition hall of the National Center for Cardiovascular Diseases, and a heat map of the risk and risk factors of cardiovascular disease populations at the national district and county levels was presented on the large screen.
"Green indicates low risk, yellow indicates high risk. Li Xi said, "The project team drew the map based on several core indicators such as the proportion of high-risk subjects for cardiovascular disease, and it can be intuitively seen that the risk of cardiovascular disease is high in Northeast China and North China, and the risk is low in South China and Central China." In addition, the specific distribution of 12 common risk factors for cardiovascular diseases, such as smoking, alcohol consumption, hypertension, hyperglycemia, hyperlipidemia, and obesity, in each region is also clear. ”
Specifically, the project team identified more than 4,400 high-risk subjects in 5 provinces, 13 counties, and 127 villages, and labeled various high-risk groups with high blood pressure and high blood sugar according to the screening results.
The project is large-scale, involving different regions and different types of staff, how to ensure the accuracy of the "portrait"? Li Xi introduced that the project team organized the release of seven types of project technical plans, operation manuals, and quality control plans, and did a good job in process monitoring. Taking the questionnaire survey involved in the project development process as an example, the project team adopted an electronic questionnaire to avoid manual handwriting errors and achieve real-time full assessment. Front-line staff can upload the questionnaire results to the NPO system in real time, and part of the data analysis can be completed in the same night. In addition, the system can accurately monitor the filling time of each question in each questionnaire and use it as the basis for judging the quality of filling.
Data treasures drive precise prevention and control
The outlined "portrait" points out the direction for the comprehensive prevention and control of cardiovascular diseases. Especially for the grassroots with weak prevention and control capabilities, the project team has many new work ideas. For example, most of the high-risk groups of cardiovascular disease need to take multiple drugs for a long time, and it is often difficult for grassroots medical staff to give scientific medication advice.
Li Xi introduced that most of the previous decision-making systems relied on clinical guidelines, which could indicate which drugs were effective in previous clinical studies. The system developed by the project team not only embeds existing clinical guidelines, drug instructions and other knowledge bases, but also deeply excavates the previous prescriptions for hypertension drugs issued by experts from Fuwai Hospital of the Chinese Academy of Medical Sciences, and can independently carry out real-world "head-to-head" drug comparative evaluation based on patient data (using standard treatment drugs or methods that have been used in clinical practice as direct control to carry out trials, which can be regarded as "direct heads-up" of the two drugs). Based on 1.1 million pieces of logic, the system can specifically suggest which drug is likely to work better among the available classes of drugs, and how the initial dose should be determined.
The project data accumulated over the past ten years is a treasure that needs to be carefully explored. The project team cleans all the latest data and uploads it to the National Project Management Office every year, providing provincial data to each province. Li Xi said that up to now, more than 200 scientific research papers have been published by relevant parties around the entire project, of which 160 have been published by provincial or county-level project offices based on local data.
Through multi-dimensional data analysis, the project team completed the evaluation of the distribution characteristics of cardiovascular disease risk factors, the current status of population risk prevention and control, the development trend of grassroots prevention and control capacity and disease burden, and reported to the National Health Commission, and wrote a specific report for each province. Li Xi learned that various provinces have actively used these reports, some as a special topic in the work report of the local health commission, and some have compiled the report into a book and published it.
Build an iron triangle prevention and control team
In the middle of a symmetrical ECG band is a red heart, with a pattern of three people holding hands. The new logo of the Early Screening and Comprehensive Intervention Program for Cardiovascular Disease Populations at High Risk was unveiled at the 10-year retrospective event, as it showed, the project is a collaborative undertaking.
Over the past 10 years, more than 2,700 organizations and 41,000 people have participated in the project. Hu Shengshou said. According to reports, the project has set up an operation management team composed of experts in clinical, epidemiology, project management, health education and other fields, and built an iron triangle prevention and control team composed of hospitals, primary medical and health institutions, and professional public health institutions at each project site. Professional public health institutions are responsible for technical support and mobilization management, primary medical and health institutions are responsible for community recruitment and resident screening, and hospitals are responsible for the examination and intervention of high-risk subjects.
As the representative of the first batch of units to join the project, Yan Wei, deputy director of the Institute of Chronic Disease Prevention and Control of Jiangxi Provincial Center for Disease Control and Prevention, came to the event site to accept the thanks and commendations from the project office. She shared with reporters the achievements of the province: "Our screening scope has expanded from 6 counties in the original 6 districted cities to 12 counties in 8 districted cities, covering about 6.88 million people, and screening out more than 40,000 high-risk subjects. ”
Yan Wei introduced that the whole project is mainly divided into four stages: initial screening, intervention of high-risk subjects, short-term follow-up and long-term follow-up. The community mobilized all residents aged 35~75 in the project area to conduct questionnaire surveys, measure blood pressure, height, weight, waist circumference, and complete blood collection. For the high-risk groups initially screened, carotid ultrasound and cardiac color ultrasound examinations are added. Staff then stratify high-risk groups and conduct short-term follow-up and comprehensive interventions within the next 3 months, and then regularly once a year thereafter.
Yan Wei felt the growth of grassroots medical staff in the development of the project: "At the beginning, some staff did not do a good job of blood pressure measurement, but now they have a deeper understanding of cardiovascular disease prevention and control. ”
Long-term follow-up is a test for the project team members. In the face of the residents' incomprehension, the flow of people, and the inconvenience of the elderly, the weak, the sick and the disabled, they must do everything possible to step on the time point and go deep into the residents' homes with instruments, and strive not to miss a single one.
Years of perseverance have been exchanged for the understanding of the people. "In the past, we couldn't bring many people to the big bara, but now many people come on tricycles to do inspections. Fan Lei, director of the intervention room of the Chronic Disease Prevention and Control Institute of the Henan Provincial Center for Disease Control and Prevention, said.
The PMO has its sights set on the next decade. "The project will continue to strengthen the early screening, early diagnosis and early treatment of cardiovascular diseases, strengthen the comprehensive assessment of individualized cardiovascular disease risks, innovate the path of multi-disease co-management, joint prevention and treatment, empower the grassroots with scientific and technological innovation, explore the 'Internet + smart healthcare' model, and gradually improve the prevention and control capabilities of the grassroots level." Hu Shengshou said.
Text: Health News reporter Wu Qian Correspondent Liu Yihua Editor: Guan Zhongyao Proofreader: Ma Yang Review: Qin Mingrui Xu Bingnan
