BP indicates blood pressure changes; CE, cost-effectiveness; DS-EHR, decision-support electronic health records; ICT, information communication technology; Lipids, control of lipid levels; LOS, length of stay; MACEs, major adverse cardiovascular events; Meds, medication adherence; NPHW, nonphysician health worker; Pt ed, patient education; QOL, quality of life; Rx sa, treatment satisfaction; and Tob, tobacco cessation.