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Home Health Monitoring Reduces Cardiovascular Disease RiskIn Medically Underserved
CommunitiesAlfred A. Bove, MD, PhD
Temple Univ. Medical SchoolPhiladelphia, Pa
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Presenter Disclosure Information
Alfred A. Bove, MD, PhD
Research Grant Astellas Pharma Significant
Consultant Insight Telehealth Systems Modest
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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
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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
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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
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Study Subjects
• Rural and Urban Subjects– Framingham risk score > 10%– No overt CVD– Age 20-75– Males and Females– Known PCP
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Primary End-Point – 5% or Greater in CVD Risk at 1 year25% - NM, 37.5% - T
Study Protocol
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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
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Protocol• Telemedicine Subjects• All Subjects
– Computer training– Sphygmomanometer– Pedometer– Log book– Scale if needed
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Study Protocol
388 Subjects completed the study
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One year Followup388 Subjects
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One Year Results
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One Year Results
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Primary End point5% Risk Reduction
P = NS
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Overall Risk Reduction
* *
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LDL Cholesterol
N = 207 (53%)
N = 181 (47%)
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Total Cholesterol
N = 207 (53%) N = 181 (47%)
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Hypertension245/388 (63%)
N = 153 (39%) N = 92 (24%)
P = 0.037
Systolic Blood Pressure
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Gender Effect
P = 0.077
P = 0.172
One-year changes
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Race Effect
P = 0.091 P = 0.048
P = 0.087
One-year changes
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Telemedicine Usage
Telemedicine92% monitored BP
> 2x
NM48% monitored BP
> 2x
Average reporting = 6.3/month
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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
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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
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