The older adult population in India is rapidly increasing, set to reach 230 million by 2036. It is estimated that by 2046, the proportion of older adults (60+ years) will surpass the proportion of children in India, marking a major demographi transition. Cardiometabolic diseases are a key driver of morbidity and mortality among older adults in India. The growing burden of multimorbidity, mental health vulnerability, financial instability and social isolation often complicate the management of cardiometabolic risk. Despite multiple policy initiatives and programs, the cardiometabolic risk in older adults remains a significant challenge. Fragmented detection, limited community involvement, and insufficient integration with mental health, rehabilitation services and social support continue to limit the progress and sustained control. These challenges present us with an opportunity to co-create sustainable people-centred solutions to optimise the detection, linkage, and management.

CARDIO-India is an innovative research project designed to address the growing burden of cardiovascular diseases (CVDs) among India’s ageing population. CVDs are the leading cause of mortality in the country, and adults aged 60 years and above are at particularly high risk, often remaining undiagnosed or poorly controlled due to late detection, fragmented continuity of care and major barriers to accessing primary and community-based services. To tackle these challenges, the programme builds on the Government of India’s Mobile Medical Units introduced under the National Health Mission in 2015, which seek to bring healthcare to the doorsteps of rural, vulnerable and underserved communities.

The overarching aim of CARDIO-INDIA is to co-create, implement and rigorously evaluate a community- and primary-health-system–based intervention for detecting and managing metabolic risk factors for CVDs. At its core, the intervention combines health technology with strengthened service delivery. A clinical decision support system helps frontline health workers follow evidence-based protocols for screening, diagnosis and treatment. An assisted telemedicine platform connects Mobile Health Units with remote specialists, improving access to expert advice. Patient-facing tools delivered through a mobile app, SMS or interactive voice response promote self management and adherence, while social workers support older adults who do not use smartphones.

The programme is organised into four work packages. The first focuses on formative research and co-creation of the intervention through in-depth interviews and focus group discussions with a range of stakeholders like patients, their family members, doctors, nurses and frontline health workers providers. The second work package evaluates the effectiveness and cost-effectiveness of the co-designed package through a cluster trial involving 48 Mobile Health Units (24 each in the intervention and control arms), with 1824 participants (912 each in the intervention and control arms). The CARDIO-INDIA intervention package, i.e. electronic decision support system, assisted telemedicine, and patient-facing tools, will be implemented for 24 months, with outcomes measured at baseline and at 12 and 24 months. The third work package uses an implementation research lens to understand the acceptability, feasibility, barriers and facilitators to adopting CARDIO-INDIA in real-world settings. The final work package focuses on scale-up by developing a practical toolkit and manual that brings together guidelines, tool inventories, training modules and standard operating procedures.

Community Engagement and Involvement are embedded throughout the project. The team will develop a bespoke CEI training module tailored to LMIC contexts and recruit, train, and position community champions in each intervention cluster. These champions will increase awareness about cardiometabolic risk factors among older adults, support engagement with services and advocate for improved provision of care in both public and private health systems.

CARDIO-INDIA is expected to achieve better control of CVD risk factors, improvements in quality of life and gains in health-adjusted life years among older Indians. In the short term, the project will generate crucial information on the design and acceptability of the intervention; in the medium term, it will provide practical implementation evidence; and in the long term, wider adoption of CARDIO-INDIA has the potential to transform the management of metabolic risk factors and substantially reduce the CVD burden in India’s ageing population.