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This study examines how home health monitoring can lower cardiovascular disease risk in medically underserved communities. The research compared nurse-managed programs with and without telemedicine support to improve cardiovascular health. Results showed a significant reduction in overall risk, cholesterol levels, and blood pressure, particularly in rural and urban underserved populations. The study highlights the potential benefits of nurse-managed cardiovascular risk reduction programs and the added value of telemedicine in enhancing blood pressure management. The findings suggest cost-effective telemedicine solutions, including automated reminders and personal health records, as practical tools for improving cardiovascular outcomes in vulnerable communities.
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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
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
