Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities...

Home Health Monitoring Reduces Cardiovascular Disease RiskIn Medically Underserved

CommunitiesAlfred A. Bove, MD, PhD

Temple Univ. Medical SchoolPhiladelphia, Pa

Presenter Disclosure Information

Alfred A. Bove, MD, PhD

Research Grant Astellas Pharma Significant

Consultant Insight Telehealth Systems Modest

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

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

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

Study Subjects

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

Primary End-Point – 5% or Greater in CVD Risk at 1 year25% - NM, 37.5% - T

Study Protocol

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

Protocol• Telemedicine Subjects• All Subjects

– Computer training– Sphygmomanometer– Pedometer– Log book– Scale if needed

Study Protocol

388 Subjects completed the study

One year Followup388 Subjects

One Year Results

One Year Results

Primary End point5% Risk Reduction

P = NS

Overall Risk Reduction

* *

LDL Cholesterol

N = 207 (53%)

N = 181 (47%)

Total Cholesterol

N = 207 (53%) N = 181 (47%)

Hypertension245/388 (63%)

N = 153 (39%) N = 92 (24%)

P = 0.037

Systolic Blood Pressure

Gender Effect

P = 0.077

P = 0.172

One-year changes

Race Effect

P = 0.091 P = 0.048

P = 0.087

One-year changes

Telemedicine Usage

Telemedicine92% monitored BP

> 2x

NM48% monitored BP

> 2x

Average reporting = 6.3/month

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

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