BMI, Waist to Height Ratio and Waist Circumference as a screening tool for Hypertension in Hospital out Patients: A Cross-Sectional, Non-inferiority study

Objective The study aimed to determine the burden of obesity, using three commonly employed metrics in the hospital outpatient setting of a developing country as predictors of hypertension through a non-inferiority study.Design A cross-sectional study design was adopted.Setting This study was conducted in Health Promotion and Risk Factor Screening Service in a tertiary Eye and ENT hospital in a semi-urban area of Nepal.Participants 2,256 randomly selected 40-69 years outpatients.Outcome measures Correlation analysis, the area under the Receiver Operating Characteristic curve, Odds ratios (OR) were calculated between three obesity metrices and hypertension.Results The prevalence of obesity and overweight by BMI was 16.09% and 42.20%, respectively; by WHtR was 32.76%, which is two times higher than obesity measured by BMI. High WC was observed among 66.76% of participants. Female participants had a greater prevalence of high WC (77.46%) than males (53.73%) (p<0.001). Prevalence of hypertension and pre-hypertension was 40.67% and 36.77%, respectively. The areas under the curve were significantly higher than 0.5 for BMI (0.593), WHtR (0.602), and WC (0.610).Conclusion WC correlated well with obesity and hypertension. It also had a higher predicting ability than WHtR and BMI to predict hypertension. WC thus proved to be non-inferior to two other commonly used metrics. It proved superior in detecting obesity in female. This inexpensive and simple non-tension tape measurement may play an important role in the future diagnosis of obesity and the prediction of HTN in resource-constrained settings of developing countries.

Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling

Background Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS). Methods LQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined. Results A sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level. Conclusion CVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups.

Abstract WP442: Process Improvement for Stroke/Cardiovascular Risk Factor Screening

Background and Purpose: Despite advances in the acute treatment of stroke, many patients are delayed in seeking care. While many factors contribute to delays, the principle factor continues to be a lack of public knowledge regarding stroke signs and symptoms. For several years, our Comprehensive Stroke team had been completing community stroke screenings independent of our CV team partners. As the risk factors for Stroke and myocardial infarction (MI) are very similar, we explored the possibility of combining our resources with our Neurological Institute staff and the Heart Institute staff. The purpose behind our process improvement project was to improve collaboration, enhance utilization of resources, and provide more comprehensive risk factor assessment and risk factor education for our participants. An additional goal included teaching the participants the signs/symptoms of Stroke and MI and the importance of calling 911 immediately. Methods: The first step was to create a team that included Neurological Institute and Heart Institute team members. We developed educational materials to be used during the events, including a comprehensive Stroke and Cardiovascular disease booklet, a Risk Factor Scorecard and other visual aids. As the project progressed, additional team members were added to meet the expanded needs identified during the screenings completed. Physician referral was incorporated for appropriate patients. Results: In 2017, the Stroke team completed 3 events and screened 180 participants with a total of 14 volunteers. In 2018, the Neurological/Heart teams completed 5 events with 180 participants screened by 57 volunteers. Thus far in 2019, the Neurological/Heart team has completed 5 events with 333 participants screened and 38 volunteers participating. Conclusions: An interdisciplinary team approach resulted in more comprehensive risk factor screening for participants, increased number of events and greater community outreach. In addition, 4 participants were referred for Cardiology appointments.