Title: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities
1Home Health Monitoring Reduces Cardiovascular
Disease RiskIn Medically Underserved Communities
- Alfred A. Bove, MD, PhD
- Temple Univ. Medical School
- Philadelphia, Pa
2Presenter Disclosure Information
Alfred A. Bove, MD, PhD
Research Grant Astellas Pharma Significant
Consultant Insight Telehealth Systems Modest
3Research 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
4Background
- 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
5Objective
- 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
6Study Subjects
- Rural and Urban Subjects
- Framingham risk score gt 10
- No overt CVD
- Age 20-75
- Males and Females
- Known PCP
7Study Protocol
Primary End-Point 5 or Greater ? in CVD Risk
at 1 year 25 - NM, 37.5 - T
8Baseline 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
9Protocol
- All Subjects
- Computer training
- Sphygmomanometer
- Pedometer
- Log book
- Scale if needed
10Study Protocol
388 Subjects completed the study
11One year Followup388 Subjects
12One Year Results
13One Year Results
14Primary End point5 Risk Reduction
P NS
15Overall Risk Reduction
16LDL Cholesterol
N 207 (53)
N 181 (47)
17Total Cholesterol
N 207 (53)
N 181 (47)
18Hypertension245/388 (63)
Systolic Blood Pressure
P 0.037
N 153 (39)
N 92 (24)
19Gender Effect
One-year changes
20Race Effect
One-year changes
P 0.087
P 0.091
P 0.048
21Telemedicine Usage
Average reporting 6.3/month
Telemedicine 92 monitored BP gt 2x
NM 48 monitored BP gt 2x
22Conclusions
- 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 -
23Implications
- 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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