Work Package 1 - Cultural and contextual adaptation of rehabilitation intervention

Co-leads: Professor Karina Lovell and Professor Imran Chaudhry

WP1 aims to co-design and co-adapt a feasible, culturally acceptable and contextually adapted, affordable home-based rehabilitation programme developed and proven in the UK (based on the Heart Manual [ref] and REACH-HF [ref] and tested in principle in a single centre trial in Bangladesh [research objectives 1-3]. It will now be adapted for people with coronary heart disease or heart failure in Bangladesh, India, and Pakistan and extended to take account of multimorbidity, including depression and anxiety. We will incorporate and co-adapt low-intensity cognitive behaviour therapy interventions for depression and anxiety (including behavioural activation/cognitive restructuring/problem solving) into the Heart Manual and REACH-HF interventions. In addition, we will develop a facilitator training programme for healthcare practitioners and an associated train-the-trainer programme, to enable the upscaling of delivery capacity.

Work Package 2 - External Pilot Trial

Co-leads: Professor Nusrat Husain and Dr Mithila Faruque

WP2 aims to determine the feasibility/acceptability of the ACROSS intervention (co-designed in WP1) and study design and to gather information to examine the parameters and processes of a full-scale trial (WP3), including recruitment, randomisation, and retention.

Work Package 3 - Hybrid effectiveness-implementation trials of ACROSS rehabilitation

Co-leads: Professor Rod Taylor and Dr Jeemon Panniyammakal

WP3 is a multicentre, multi-country study to evaluate the clinical and cost-effectiveness of the ACROSS rehabilitation programme for individuals with multimorbidity, including heart disease and mental health disorders, across three South Asian countries [research objectives 4 & 5]. It also investigates factors influencing wider implementation in low- and middle-income countries (LMICs).

Work Package 4 - Capacity Building

Co-leads: Dr Amy Blakemore and Jamal Uddin

WP4’s primary goal is to enhance research and rehabilitation delivery capacity in our LMIC partner organisations and foster knowledge exchange between the UK and LMICs [research objectives 6 & 7]. To help us achieve this, ACROSS has developed partnerships with three organisations: the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), the Heart Manual Office UK, and the Global Health Network (TGHN). These organisations provide expertise in online rehabilitation training and global health research support.

References 

  1. Vaduganathan M, Mensah GA, Turco JV, et al.: The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol. 2022; 80(25): 2361–2371. PubMed Abstract | Publisher Full Text
  2. Roth GA, Mensah GA, Johnson CO, et al.: Global burden of cardiovascular diseases writing group. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020; 76(25): 2982–3021. PubMed Abstract | Publisher Full Text | Free Full Tex
  3. World health association global status report on noncommunicable diseases 2010. Geneva, Switzerland, 2011. Reference Source
  4. Ramaraj R, Chellappa P: Cardiovascular risk in South Asians. Postgrad Med J. 2008; 84(996): 518–23. PubMed Abstract | Publisher Full Text
  5. Dragioti E, Radua J, Solmi M, et al.: Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatry. 2023; 22(1): 86–104. PubMed Abstract | Publisher Full Text | Free Full Text
  6. Mulugeta H, Sinclair PM, Wilson A: Prevalence of depression and its association with health-related Quality of Life in people with heart failure in low- and middle-income countries: a systematic review and meta-analysis. PLoS One. 2023; 18(3): e0283146. PubMed Abstract | Publisher Full Text | Free Full Text