Primary Care–Centred Integrated Care for Cardiovascular Risk Reduction in Rural China: A Cluster-Randomized Controlled Trial
1
China Center of Health Development Studies, Peking University, Beijing, China
2
College of Integrated Health Sciences, University at Albany-State University of New York, New York, United States
3
Brown School, Washington University in St. Louis, Missouri, United States
Popul. Med. 2026;8(Supplement Supplement 1):A3032
ABSTRACT
BACKGROUND:
Cardiovascular disease (CVD) is the leading cause of premature mortality worldwide, especially in low- and middle-income countries. In China, primary care often lacks specialist support and capacity for CVD risk-targeted prevention. Evidence on cardiovascular risk–stratified integrated care in primary care also remains limited. This study evaluated the effectiveness of a risk-stratified integrated care model for CVD prevention in rural China.
METHODS:
C-RISIMA was a parallel-arm, cluster-randomized controlled trial conducted in 64 villages across two counties in eastern and western China. Villages were randomized (1:1) to usual care or intervention. The intervention integrated specialists into family doctor teams and applied a WHO 10-year CVD risk–based care pathway with team-based incentives. A total of 2,560 adults aged 40–70 years with hypertension and/or diabetes were enrolled. The primary outcome was change in WHO 10-year CVD risk from baseline to 6 months. Secondary outcomes included blood pressure and other cardiovascular risk factors. Mixed-effects models accounted for village-level clustering.
RESULTS:
Of the 2,560 participants enrolled at baseline, 2,446 (95.5%) completed the 6-month follow-up and were included in the primary analysis. At 6 months, the intervention group showed a significantly greater reduction in mean WHO 10-year CVD risk than the control group (−0.97 percentage points; 95% CI −1.54 to −0.41). Systolic blood pressure declined by an additional 3.51 mmHg in the intervention group (95% CI −5.37 to −1.65). Effects were consistent across cardiovascular risk strata, with larger absolute reductions among higher-risk participants. No significant effect on other risk factors was observed.
CONCLUSIONS:
A primary care–centred, cardiovascular risk–stratified integrated care model achieved meaningful short-term reductions in predicted CVD risk and blood pressure in rural settings. Aligning care intensity with patient risk and strengthening primary care teams may provide an sustainable approach to CVD prevention in resource-constrained contexts within routine primary healthcare delivery systems globally.
Cardiovascular disease (CVD) is the leading cause of premature mortality worldwide, especially in low- and middle-income countries. In China, primary care often lacks specialist support and capacity for CVD risk-targeted prevention. Evidence on cardiovascular risk–stratified integrated care in primary care also remains limited. This study evaluated the effectiveness of a risk-stratified integrated care model for CVD prevention in rural China.
METHODS:
C-RISIMA was a parallel-arm, cluster-randomized controlled trial conducted in 64 villages across two counties in eastern and western China. Villages were randomized (1:1) to usual care or intervention. The intervention integrated specialists into family doctor teams and applied a WHO 10-year CVD risk–based care pathway with team-based incentives. A total of 2,560 adults aged 40–70 years with hypertension and/or diabetes were enrolled. The primary outcome was change in WHO 10-year CVD risk from baseline to 6 months. Secondary outcomes included blood pressure and other cardiovascular risk factors. Mixed-effects models accounted for village-level clustering.
RESULTS:
Of the 2,560 participants enrolled at baseline, 2,446 (95.5%) completed the 6-month follow-up and were included in the primary analysis. At 6 months, the intervention group showed a significantly greater reduction in mean WHO 10-year CVD risk than the control group (−0.97 percentage points; 95% CI −1.54 to −0.41). Systolic blood pressure declined by an additional 3.51 mmHg in the intervention group (95% CI −5.37 to −1.65). Effects were consistent across cardiovascular risk strata, with larger absolute reductions among higher-risk participants. No significant effect on other risk factors was observed.
CONCLUSIONS:
A primary care–centred, cardiovascular risk–stratified integrated care model achieved meaningful short-term reductions in predicted CVD risk and blood pressure in rural settings. Aligning care intensity with patient risk and strengthening primary care teams may provide an sustainable approach to CVD prevention in resource-constrained contexts within routine primary healthcare delivery systems globally.
| eISSN: | 2654-1459 |
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