Coronary heart disease is the leading cause of death in India and typically afflicts people at ages 6-10 years younger than in high-income countries, often presenting as acute events such as heart attacks. Simple, inexpensive inpatient care checklists for healthcare providers have improved heart attack care considerably in high-income countries such as the United States, but these have not been widely developed, implemented, nor studied in India, despite the variability of care, rising burden of disease, and potential for improved clinical outcomes. The ACS QUIK grant is a cluster-randomized, stepped wedge clinical trial that aims to reduce morbidity and mortality associated with ACS in Kerala. Drs. David Victorson (Medical Social Sciences) and Mark Huffman (Preventive Medicine; Medicine-Cardiology), and their Indian collaborators, Drs. PP Mohanan (Westfort Hi-Tech Hospital, Ltd., Thrissur) and D. Prabhakaran (Centre for Chronic Disease Control, New Delhi) aim to use local expertise to develop an acute coronary syndrome quality improvement toolkit after having identified gaps in optimal care through their analysis of the Kerala ACS Registry of more than 25,000 ACS admissions.
In December 2012, Drs. Victorson and Huffman, traveled to the south Indian state of Kerala to conduct focus groups and interviews with local cardiologists, internists, nurses, and policymakers to learn more about heart attack care in the state. Kerala is a leader in many social development indices within India, but also appears to have some of the highest prevalence rates of cardiovascular disease in India. The pair also had the chance to meet with the state health secretary of Kerala, Dr. Rajeev Sadanandan (see photo), who expressed interest in expanding the state's emphasis on improved quality of care from maternal and infant peri-natal outcomes to ACS, a leading cause of death in India. The visit led to a forthcoming opinion piece from the group that extrapolates the concept of community-engaged research between communities and universities to the field of global health initiatives between high- and low- and middle-income countries —moving from "curbside to countryside," as coined by Dr. Victorson—which serves as one example of the cross-collaborative potential of Northwestern University.
National Heart, Lung, and Blood Institute
Countries: India (Kerala State)
Mark Huffman, MD/MPH (Northwestern University)
David E Victorson, PhD (Northwestern University)
Donald Lloyd-Jones, MD, ScM (Northwestern University)
Joseph Kang, PhD (Northwestern University)
Robert O Bonow, MD (Northwestern University)
Centre for Chronic Disease Control, New Delhi
Westfort Hi-Tech Hospital, Ltd., Thrissur