2. Internet-based Telemedicine for Cardiovascular Disease Management Alfred A. Bove, MD, PhD Cardiology Section Temple University Medical Center

3. Why Telemedicine? Shift in incidence from acute to chronic disease Heart Failure Hypertension Diabetes Respiratory Disease Renal Disease

4. New Concepts Toward a National Health Information Infrastructure June 2000 National Committee on Vital and Health Statistics

5. Heart Failure Demographics Heart Failure patients The graph shows an increasing incidence of heart failure patients from 1970 to 2040

6. HF Telephone Intervention Grancelli H, Varini S, Ferrante D, Schwartzman R, Zambrano C, Soifer S, Nul D, Doval H; GESICA Investigators. J Card Fail. 2003 Jun;9(3):172-9. The graph shows a reduction in hospitalization for heart failure in patients using a telephone surveillance system. P = 0.69P =.005 1518 pts 20 mos

7. Telephone Surveillance 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. 47 pts 20 mos

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

9. Patient Management The figure shows a screen from the Internet communication system used for hypertension management

10. Patient Management Graphics The figure shows a screen from the Internet communication system used for hypertension management

11. 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

12. CVD Risk High in Underserved populations Inadequate care availability Inadequate health education The “Medical Divide” Increased Obesity/Metabolic Syndrome

13. CVD Risk Management Record Risk Factors The figure shows a web screen used for cardiovascular risk management

14. Patient Management Make a personal Health file The figure shows a web screen used for cardiovascular risk management

15. Patient Management Provide longitudinal feedback The figure shows a web screen used for cardiovascular risk management

16. Patient management Provide education The figure shows a web screen used for cardiovascular risk management

17. Risk Factors Rural vs. Urban This slide shows the distribution of risk factors in urban and rural subjects

18. Health Knowledge This slide shows the health knowledge scores in Urban and Rural subjects

19. Baseline data

20. Rural vs. Urban risk * * This slide shows the improvement in risk factors in urban and rural subjects

21. Clinical vs. Telemedicine Blood Lipids * * * * This slide shows the changes in blood lipids in subjects using the telemedicine system compared to a control group

22. 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

23. 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

24. Clinical vs. Telemedicine ** This slide shows the changes in CVD risk score in subjects using the telemedicine system compared to a control group

25. Telemedicine Use 22% of the clinical group monitored health status

26. Managing Hypertension Over 65 million patients Most not at goal BP Problem with medication adherence Increased risk: Heart disease Stroke Renal failure

27. Patient Centered Therapy Knowledge Goal BP (guideline-based) Lifestyle effects Diet effects Medication effects Surveillance Self measured BP Weekly reporting Communication Internet Telephone

28. Reporting Patient - monthly summaries via mail Physician - monthly summaries via fax Quality Education BP goal Lifestyle changes Medication appropriateness Patient Centered Therapy

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

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

31. Information Infrastructure INFORMATION CENTER SERVER PROVIDER INTERNET HOSPITAL CLINIC PATIENT WIRELESS PHARMACY PATIENT This slide shows the new configuration of our Internet-based hypertension management system, and future concepts for health information

32. 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