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

2. Presenter Disclosure Information Alfred A. Bove, MD, PhD Research GrantAstellas PharmaSignificant ConsultantInsight Telehealth SystemsModest

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. Recruitment Informed Consent Assessment, Training, Randomization Nurse Management 4 office visits note to patient and PCP Nurse Management+Telemedicine 4 office visits Internet reporting note to patient and PCP Primary End-Point – 5% or Greater in CVD Risk at 1 year 25% - NM, 37.5% - T Study Protocol

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 Computer Training 465 passed Randomized NM 228 NM+T 237 2 failed 388 Subjects completed the study

11. One year Followup 388 Subjects

12. One Year Results

14. Primary End point 5% 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. Hypertension 245/388 (63%) N = 153 (39%)N = 92 (24%) P = 0.037 Systolic Blood Pressure

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

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

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

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