Download - Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities
![Page 1: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/1.jpg)
Home Health Monitoring Reduces Cardiovascular Disease RiskIn Medically Underserved
CommunitiesAlfred A. Bove, MD, PhD
Temple Univ. Medical SchoolPhiladelphia, Pa
![Page 2: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/2.jpg)
Presenter Disclosure Information
Alfred A. Bove, MD, PhD
Research Grant Astellas Pharma Significant
Consultant Insight Telehealth Systems Modest
![Page 3: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/3.jpg)
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
![Page 4: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/4.jpg)
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
![Page 5: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/5.jpg)
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
![Page 6: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/6.jpg)
Study Subjects
• Rural and Urban Subjects– Framingham risk score > 10%– No overt CVD– Age 20-75– Males and Females– Known PCP
![Page 7: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/7.jpg)
Primary End-Point – 5% or Greater in CVD Risk at 1 year25% - NM, 37.5% - T
Study Protocol
![Page 8: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/8.jpg)
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
![Page 9: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/9.jpg)
Protocol• Telemedicine Subjects• All Subjects
– Computer training– Sphygmomanometer– Pedometer– Log book– Scale if needed
![Page 10: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/10.jpg)
Study Protocol
388 Subjects completed the study
![Page 11: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/11.jpg)
One year Followup388 Subjects
![Page 12: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/12.jpg)
One Year Results
![Page 13: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/13.jpg)
One Year Results
![Page 14: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/14.jpg)
Primary End point5% Risk Reduction
P = NS
![Page 15: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/15.jpg)
Overall Risk Reduction
* *
![Page 16: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/16.jpg)
LDL Cholesterol
N = 207 (53%)
N = 181 (47%)
![Page 17: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/17.jpg)
Total Cholesterol
N = 207 (53%) N = 181 (47%)
![Page 18: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/18.jpg)
Hypertension245/388 (63%)
N = 153 (39%) N = 92 (24%)
P = 0.037
Systolic Blood Pressure
![Page 19: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/19.jpg)
Gender Effect
P = 0.077
P = 0.172
One-year changes
![Page 20: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/20.jpg)
Race Effect
P = 0.091 P = 0.048
P = 0.087
One-year changes
![Page 21: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/21.jpg)
Telemedicine Usage
Telemedicine92% monitored BP
> 2x
NM48% monitored BP
> 2x
Average reporting = 6.3/month
![Page 22: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/22.jpg)
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
![Page 23: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/23.jpg)
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
![Page 24: Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities](https://reader036.vdocument.in/reader036/viewer/2022070404/56813a4a550346895da24011/html5/thumbnails/24.jpg)