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Internet-based Telemedicine for Cardiovascular Disease Management

Internet-based Telemedicine for Cardiovascular Disease Management Alfred A. Bove, MD, PhD Cardiology Section Temple University Medical Center Why Telemedicine? Shift in incidence from acute to chronic disease Heart Failure Hypertension Diabetes Respiratory Disease Renal Disease

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Internet-based Telemedicine for Cardiovascular Disease Management

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  1. Internet-based Telemedicine for Cardiovascular Disease Management Alfred A. Bove, MD, PhD Cardiology Section Temple University Medical Center

  2. Why Telemedicine? • Shift in incidence from acute to chronic disease • Heart Failure • Hypertension • Diabetes • Respiratory Disease • Renal Disease

  3. New Concepts Toward a National Health Information Infrastructure June 2000 National Committee on Vital and Health Statistics

  4. Heart Failure Demographics • Heart Failure patients The graph shows an increasing incidence of heart failure patients from 1970 to 2040

  5. Telephone Surveillance 47 pts 20 mos Chrysogelos E et.al . J Card Fail. 2000; 6:II-6. The graph shows a reduction in hospitalization and ED visits in heart failure patients using a telephone surveillance system.

  6. Telehealth System The diagram shows the connections between the patient, provider and information database via the internet for communications.

  7. Patient Management The figure shows a screen from the Internet communication system used for hypertension management

  8. 48 pts 12 mos P = 0.025 The graph shows a reduction in hospital days in patients with heart failure who used our Internet communication system. Kashem at al. J. Cardiac Failure 2008

  9. CVD Risk • High in Underserved populations • Inadequate care availability • Inadequate health education • The “Medical Divide” • Increased Obesity/Metabolic Syndrome

  10. CVD Risk Management • Record Risk Factors The figure shows a web screen used for cardiovascular risk management

  11. Patient Management • Provide longitudinal feedback The figure shows a web screen used for cardiovascular risk management

  12. Risk Factors • Rural vs. Urban This slide shows the distribution of risk factors in urban and rural subjects

  13. Clinical vs. Telemedicine • Blood Lipids * * * * This slide shows the changes in blood lipids in subjects using the telemedicine system compared to a control group

  14. Clinical vs. Telemedicine • Systolic Blood Pressure * * This slide shows the changes in systolic blood pressure in subjects using the telemedicine system compared to a control group

  15. Clinical vs. Telemedicine This slide shows the time course of changes in systolic blood pressure over a one year period in subjects using the telemedicine system compared to a control group

  16. Clinical vs. Telemedicine * * This slide shows the changes in CVD risk score in subjects using the telemedicine system compared to a control group

  17. Managing Hypertension • Over 65 million patients • Most not at goal BP • Problem with medication adherence • Increased risk: • Heart disease • Stroke • Renal failure

  18. Patient Centered Therapy • Knowledge • Goal BP (guideline-based) • Lifestyle effects • Diet effects • Medication effects • Surveillance • Self measured BP • Weekly reporting • Communication • Internet • Telephone

  19. Patient Centered Therapy • Reporting • Patient - monthly summaries via mail • Physician - monthly summaries via fax • Quality • Education • BP goal • Lifestyle changes • Medication appropriateness

  20. Internet Use This slide shows a web screen used for our Internet-based hypertension management system

  21. Internet Use This slide shows a web screen used for our Internet-based hypertension management system

  22. CLINIC HOSPITAL PHARMACY PATIENT INTERNET PATIENT SERVER WIRELESS PROVIDER Information Infrastructure INFORMATION CENTER This slide shows the new configuration of our Internet-based hypertension management system, and future concepts for health information

  23. What Works for Telemedicine • Chronic Illness • Patient participation • Care team includes the patient • Home monitored status • Hypertension • Heart Failure • Diabetes • COPD/Asthma • Easy Communication • Expectation/empowerment

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