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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

Internet-based Telemedicine for Cardiovascular Disease Management

Alfred A. Bove, MD, PhD

Cardiology Section

Temple University Medical Center

why telemedicine
Why Telemedicine?
  • Shift in incidence from acute to chronic disease
    • Heart Failure
    • Hypertension
    • Diabetes
    • Respiratory Disease
    • Renal Disease
new concepts
New Concepts

Toward a National Health Information Infrastructure

June 2000

National Committee on Vital and Health Statistics

heart failure demographics
Heart Failure Demographics
  • Heart Failure patients

The graph shows an increasing incidence of heart failure patients from 1970 to 2040

telephone surveillance
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.

telehealth system
Telehealth System

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

patient management
Patient Management

The figure shows a screen from the Internet communication system used for hypertension management

slide9

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

cvd risk
CVD Risk
  • High in Underserved populations
    • Inadequate care availability
    • Inadequate health education
      • The “Medical Divide”
    • Increased Obesity/Metabolic Syndrome
cvd risk management
CVD Risk Management
  • Record Risk Factors

The figure shows a web screen used for cardiovascular risk management

patient management12
Patient Management
  • Provide longitudinal feedback

The figure shows a web screen used for cardiovascular risk management

risk factors
Risk Factors
  • Rural vs. Urban

This slide shows the distribution of risk factors in urban and rural subjects

clinical vs telemedicine
Clinical vs. Telemedicine
  • Blood Lipids

*

*

*

*

This slide shows the changes in blood lipids in subjects using the telemedicine system compared to a control group

clinical vs telemedicine15
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

clinical vs telemedicine16
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

clinical vs telemedicine17
Clinical vs. Telemedicine

*

*

This slide shows the changes in CVD risk score in subjects using the telemedicine system compared to a control group

managing hypertension
Managing Hypertension
  • Over 65 million patients
  • Most not at goal BP
  • Problem with medication adherence
  • Increased risk:
    • Heart disease
    • Stroke
    • Renal failure
patient centered therapy
Patient Centered Therapy
  • Knowledge
    • Goal BP (guideline-based)
    • Lifestyle effects
    • Diet effects
    • Medication effects
  • Surveillance
    • Self measured BP
    • Weekly reporting
  • Communication
    • Internet
    • Telephone
patient centered therapy20
Patient Centered Therapy
  • Reporting
    • Patient - monthly summaries via mail
    • Physician - monthly summaries via fax
  • Quality
    • Education
    • BP goal
    • Lifestyle changes
    • Medication appropriateness
internet use
Internet Use

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

internet use22
Internet Use

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

information infrastructure

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

what works for telemedicine
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