Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities

Home Health Monitoring Reduces Cardiovascular Disease RiskIn 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 • 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

Study Protocol Primary End-Point – 5% or Greater  in CVD Risk at 1 year 25% - NM, 37.5% - T

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

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%) Systolic Blood Pressure P = 0.037 N = 153 (39%) N = 92 (24%)

Gender Effect One-year changes P = 0.077 P = 0.172

Race Effect One-year changes P = 0.087 P = 0.091 P = 0.048

Telemedicine Usage Average reporting = 6.3/month Telemedicine 92% monitored BP > 2x NM 48% monitored BP > 2x

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

Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities