Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities
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Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities Alfred A. Bove, MD, PhD Temple Univ. Medical School Philadelphia, Pa
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Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities. Alfred A. Bove, MD, PhD Temple Univ. Medical School Philadelphia, Pa. Presenter Disclosure Information. Alfred A. Bove, MD, PhD. Research Team. Temple University Medical Center AA Bove, MD, PhD - PowerPoint PPT Presentation
Transcript of 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
