Junli Zuo
Ruijin Hospital Shanghai Jiaotong University School of Medicine
"Central Hypertension"‚ in China: Towards the nation-wide use of SphygmoCor technology for health monitoring in community clinics throughout China, using the Jiading District of Shanghai as a model, with a cohort of 200,000
#Cardiovascular #Women's Health
How will the SphygmoCor® technology enable, enhance, or accelerate your research?
The addition of an XCEL device and 20 CONNEQT Pulse units will deliver a substantial value-added component to our research and clinical activities as well as to CardieX/AtCor itself. We already have an XCEL device, and an additional device will enhance and accelerate hospital outpatient data collection. The addition of a Pulse device in all Jading community clinics will establish the utility of the device as a reliable clinic and home monitoring device for collection of data on central aortic pressure and associated parameters. It will also facilitate and enhance collection of important baseline data in all clinics undergoing health assessments with cohorts of approximately 15,000 in each clinic. The data will then be used to provide potential recommendations to local government for deployment of the CONNEQT Pulse for home monitoring in all participants of all Jiading clinics. After some 12 months of the initial use of the 20 devices there could be a potential for deployment of over 200,000 CONNEQT Pulse devices. Following this initial phase in Jading district, a case will be made to engage community clinics in all other districts of greater Shanghai. This would involve all 251 clinics across the city with a total coverage of over 3,000,000. This will complement information already available in the Internation Database for Central Arterial Properties for Risk Assessment (IDCARS), all of which is already exclusively based on SphygmoCor measurements and which has generated important publications (Cheng YB, et al Hypertension. 2022;79(5):1101-1111).
Executive Summary
The increase in the burden of cardiovascular risk in China is driving efforts for enhanced monitoring and early prevention. The SpygmoCor technology will enable data collection in the community to establish the presence of “central hypertension”. Dr Junli Zuo, is in charge of the General Practitioner Training Program across 13 community clinics in Jiading, with a catchment of over 200,000. She makes recommendations on health assessments as well as conducting research projects. She has published extensively on outcome studies of arterial stiffness and central aortic pressure and this experience will provide a solid background for the use of SphygmoCor technology. The initial aim is to introduce the CONNEQT Pulse devices in all community clinics to collect data in patients attending clinics for health assessments, following which proposals will be made to Jiading health authorities to support the use of the Pulse device in all 13 clinics for home monitoring for all patients registered each clinic (each clinic has approximately 15,000 registered patients). The addition of an XCEL unit and 20 CONNEQT Pulse devices will enhance studies in the 4 main areas relevant to this application: (i) Reference values of central aortic pressure and arterial stiffness in the normal Chinese population; (ii) Classification of categories of vascular ageing and hypertension phenotypes; (iii) assessment of central aortic pressure indices and arterial stiffness for maternal health in relation to preeclampsia; (iv) Collection of ShygmoCor-related data in remote areas of populations at high altitude. The 13 clinics in Jiading and the data collected will be used as a model to make a case for deployment of CONNEQT Pulse devices throughout the 251 community clinics in greater Shanghai (total catchment of approximately 3,000,000). A desirable future outcome is to use the Shanghai experience to expand to community clinics throughout the whole of China.
Research Setting
The applicant, Dr Junli Zuo, is Director of the Department of Geriatric Medicine at the Ruijin Hospital located in the Jiading District of northern Shanghai, a hospital with a very large outpatient department (1,150,000 in 2018). She has obtained General Practitioner (GP) certification from the Shanghai Municipal Health Commission, and this has enabled her to be the Director of the GP Training Program encompassing 13 Community Clinics in Jiading district, with a total clinic patient catchment of the order of 200,000. She advise all Community Clinic managers on GP and health matters and makes recommendations to all clinics on implementation of health assessments and research projects associated with Ruijin Hospital in Jiading. In the context of declining birthrate and mitigation of complications such a preeclampsia, a large body of data will be collected from this cohort regarding assessment of maternal health. Dr Zuo also advises the management of the main Hospital in Shangri-La (altitude 3,300 m) in the province of Yunnan on the benefit of collecting health assessment data to identify cardiovascular risk factors of populations living at high altitude. She and her team currently have a funded project to collect data on a cohort of 2000 partiapnts going through the Diqing State People’s Hospital at Shangri-La using the XCEL SphygmoCor device, and to associate pulse wave analysis parameters of central aortic pressure and pulse wave velocity with target organ damage. The team at Shangri-La has already been trained on the use of the SphygmoCor equipment.