Home Health Monitoring Reduces Cardiovascular Disease Risk In Medically Underserved Communities

1. Home Health Monitoring Reduces Cardiovascular Disease RiskIn Medically Underserved Communities Alfred A. Bove, MD, PhD Temple Univ. Medical School Philadelphia, Pa

2. Presenter Disclosure Information Alfred A. Bove, MD, PhD

3. 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

4. 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

5. 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

6. Study Subjects • Rural and Urban Subjects • Framingham risk score > 10% • No overt CVD • Age 20-75 • Males and Females • Known PCP

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

8. 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

9. Protocol • Telemedicine Subjects • All Subjects • Computer training • Sphygmomanometer • Pedometer • Log book • Scale if needed

10. Study Protocol 388 Subjects completed the study

11. One year Followup388 Subjects

12. One Year Results

13. One Year Results

14. Primary End point5% Risk Reduction P = NS

15. Overall Risk Reduction * *

16. LDL Cholesterol N = 207 (53%) N = 181 (47%)

17. Total Cholesterol N = 207 (53%) N = 181 (47%)

18. Hypertension245/388 (63%) Systolic Blood Pressure P = 0.037 N = 153 (39%) N = 92 (24%)

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

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

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

22. 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

23. 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