Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities

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Home Health Monitoring Reduces Cardiovascular
Disease RiskIn Medically Underserved Communities

• Alfred A. Bove, MD, PhD
• Temple Univ. Medical School
• Philadelphia, Pa

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Presenter Disclosure Information
Alfred A. Bove, MD, PhD

Research Grant Astellas Pharma Significant
Consultant Insight Telehealth Systems Modest
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Research Team

• Temple University Medical Center
• AA Bove, MD, PhD
• WP Santamore, PhD
• CJ Homko, RN, PHD
• RC Cross, MD
• AM Kashem, MD

• Geisinger Medical Center
• FJ Menapace, MD
• TR McConnell, PhD
• J Shirk, RN

Funded by the Pennsylvania Dept of Health
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Background

• CV morbidity and mortality are increased in
  underserved and minority communities
• CV risk is increased in these communities
• Obesity
• Diabetes
• Hypertension
• Hyperlipidemia
• Frequent Communication improves CVD risk
• Telephone
• mail

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Objective

• Lower Cardiovascular Disease Risk in Urban and
  Rural Underserved Communities
• Compare
• a Nurse management program 4 visits in one year
  vs.
• Nurse management plus weekly reporting of CVD
  risk factors via Telemedicine

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Study Subjects

• Rural and Urban Subjects
• Framingham risk score gt 10
• No overt CVD
• Age 20-75
• Males and Females
• Known PCP

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Study Protocol
Primary End-Point 5 or Greater ? in CVD Risk
at 1 year 25 - NM, 37.5 - T
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Baseline Assessment

• History, Physical exam, ECG
• Blood Lipids, Metabolic panel, A1c, CRP
• Six Minute Walk Test
• Questionnaires
• Medical Knowledge,
• Health Locus of Control,
• Self-Efficacy,
• Diabetes Empowerment
• Education, Family income

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Protocol

• Telemedicine Subjects

• All Subjects
• Computer training
• Sphygmomanometer
• Pedometer
• Log book
• Scale if needed

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Study Protocol
388 Subjects completed the study
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One year Followup388 Subjects
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One Year Results
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One Year Results
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Primary End point5 Risk Reduction
P NS
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Overall Risk Reduction


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LDL Cholesterol
N 207 (53)
N 181 (47)
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Total Cholesterol
N 207 (53)
N 181 (47)
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Hypertension245/388 (63)
Systolic Blood Pressure
P 0.037
N 153 (39)
N 92 (24)
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Gender Effect
One-year changes
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Race Effect
One-year changes
P 0.087
P 0.091
P 0.048
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Telemedicine Usage
Average reporting 6.3/month
Telemedicine 92 monitored BP gt 2x
NM 48 monitored BP gt 2x
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Conclusions

• A nurse management program can reduce CVD risk
  in medically underserved communities
• Telemedicine provides additional benefit for
  Blood Pressure management
• Male and female subjects achieved similar
  improvements in BP and lipids
• White subjects achieve lower BP and lipid values
  compared to African Americans

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Implications

• Nurse Managed CVD risk reduction potentially can
  significantly reduce CVD morbidity and mortality
• However cost for this management is prohibitive
• Telemedicine provides a low cost complementary
  risk reduction tool
• Automated reminders via web and telephone
• PHR for archiving data and providing portability
• Timely feedback and advice for risk management

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