Key result
Multicomponent C-QIP strategy boosts ischemic heart disease GDMT use ~45% over usual care.
Why the study?
Chronic cardiovascular disease care quality remains suboptimal globally, and the feasibility and effect of a multicomponent quality improvement strategy in India were unknown.
Does a multicomponent collaborative quality improvement strategy improve the feasibility and quality of chronic cardiovascular disease care in adults attending outpatient clinics in India compared to usual care?
RCT (n=410)
Open-label
1:1 randomization with varied block size
Yes
Does a multicomponent collaborative quality improvement strategy improve the feasibility and quality of chronic cardiovascular disease care in adults attending outpatient clinics in India compared to usual care?
Absolute Event Rate: 93.2% vs 91.7%
A multicomponent collaborative quality improvement strategy is both feasible and highly acceptable in Indian outpatient clinics, significantly enhancing adherence and evidence-based prescribing for chronic cardiovascular diseases.
Supports C-QIP adoption in Indian outpatient clinics to raise GDMT use; extends multicomponent QI evidence to LMIC chronic CVD care.
Background Chronic cardiovascular diseases (CVD) care quality remains suboptimal, globally. We assessed the feasibility, acceptability, fidelity, and preliminary effect of a multicomponent, collaborative quality improvement (C-QIP) strategy among patients with CVD attending outpatient clinics in India. Methods and findings In this pragmatic feasibility randomized controlled trial, 410 adults with ischemic heart disease, ischemic stroke, or heart failure attending four public and private hospitals were randomized to C-QIP (electronic decision support for providers, non-physician care coordination, patient education, text-message reminders, and audit-feedback) or usual care. Primary outcomes were feasibility, fidelity, adoption, and acceptability; secondary outcomes included guideline-directed medical therapy (GDMT), self-reported adherence, care processes, and risk factors. At end of study (median follow-up 15 months), retention was 192/206 (93.2%) in C-QIP and 187/204 (91.7%) in usual care. Fidelity was high: 187/198 (94.4%) C-QIP participants received lifestyle counseling at end of study. C-QIP increased GDMT use for ischemic heart disease (58.3% versus 32.4%; relative risk [RR] 1.45, 95% CI [1.18, 1.78]) and ischemic stroke (76.7% versus 31.8%; RR 2.41, 95% CI [1.52, 3.81]), but not heart failure. Self-reported adherence was higher for medications (90.9% versus 82.3%; RR 1.08, 95% CI [1.04, 1.12]), diet (91.9% versus 82.3%; RR 1.07, 95% CI [1.02, 1.13]), and physical activity (91.4% versus 70.4%; RR 1.23, 95% CI [1.16, 1.30]). Limitations include feasibility design, individual randomization within shared clinics, and limited power for clinical outcomes and subgroup analysis. Conclusions The C-QIP trial demonstrated that a multicomponent strategy is feasible, acceptable, and improved chronic CVD care processes in India. Future large, confirmatory hybrid trials are needed to establish whether such quality improvement strategies can reduce cardiovascular morbidity and mortality. Trial Registrations NCT05196659 ; CTRI/2022/04/041847
No takes yet. Share an insight, caveat, or question.
Singh et al. (2026) conducted an RCT in Ischemic heart disease, ischemic stroke, or heart failure (n=410). Collaborative quality improvement (C-QIP) strategy vs. Usual care was evaluated on Feasibility (retention at end of study). The multicomponent C-QIP strategy was highly feasible (93.2% retention) and significantly improved guideline-directed medical therapy use for ischemic heart disease (RR 1.45) and stroke (RR 2.41) compared to usual care.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: