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Effectiveness of a Remote Hypertension and Lipid Management Program
TAKE-HOME MESSAGE
- This study assessed the effectiveness of a remote hypertension and dyslipidemia care platform in 10,803 patients from a large integrated healthcare system. The authors found that patients in the remote care program (education, home blood pressure device integration, and medication titration) had a more significant reduction in blood pressure and LDL-C measurements than patients who received education only. The rates of enrollment and beneficial improvements in blood pressure and lipid management was consistent across different racial, ethnic, and language groups.
- These findings highlight the opportunity to use innovative approaches to improve the management of cardiovascular risk factors in real-world settings. Further research can help clarify the optimal ways to target tech-enabled care across different populations and diverse clinical contexts for high-value care.
abstract
This abstract is available on the publisher's site.
Access this abstract nowIMPORTANCE
Blood pressure (BP) and cholesterol control remain challenging. Remote care can deliver more effective care outside of traditional clinician-patient settings but scaling and ensuring access to care among diverse populations remains elusive.
OBJECTIVE
To implement and evaluate a remote hypertension and cholesterol management program across a diverse health care network.
DESIGN, SETTING, AND PARTICIPANTS
Between January 2018 and July 2021, 20 454 patients in a large integrated health network were screened; 18 444 were approached, and 10 803 were enrolled in a comprehensive remote hypertension and cholesterol program (3658 patients with hypertension, 8103 patients with cholesterol, and 958 patients with both). A total of 1266 patients requested education only without medication titration. Enrolled patients received education, home BP device integration, and medication titration. Nonlicensed navigators and pharmacists, supported by cardiovascular clinicians, coordinated care using standardized algorithms, task management and automation software, and omnichannel communication. BP and laboratory test results were actively monitored.
MAIN OUTCOMES AND MEASURES
Changes in BP and low-density lipoprotein cholesterol (LDL-C).
RESULTS
The mean (SD) age among 10 803 patients was 65 (11.4) years; 6009 participants (56%) were female; 1321 (12%) identified as Black, 1190 (11%) as Hispanic, 7758 (72%) as White, and 1727 (16%) as another or multiple races (including American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, unknown, other, and declined to respond; consolidated owing to small numbers); and 142 (11%) reported a preferred language other than English. A total of 424 482 BP readings and 139 263 laboratory reports were collected. In the hypertension program, the mean (SD) office BP prior to enrollment was 150/83 (18/10) mm Hg, and the mean (SD) home BP was 145/83 (20/12) mm Hg. For those engaged in remote medication management, the mean (SD) clinic BP 6 and 12 months after enrollment decreased by 8.7/3.8 (21.4/12.4) and 9.7/5.2 (22.2/12.6) mm Hg, respectively. In the education-only cohort, BP changed by a mean (SD) -1.5/-0.7 (23.0/11.1) and by +0.2/-1.9 (30.3/11.2) mm Hg, respectively (P < .001 for between cohort difference). In the lipids program, patients in remote medication management experienced a reduction in LDL-C by a mean (SD) 35.4 (43.1) and 37.5 (43.9) mg/dL at 6 and 12 months, respectively, while the education-only cohort experienced a mean (SD) reduction in LDL-C of 9.3 (34.3) and 10.2 (35.5) mg/dL at 6 and 12 months, respectively (P < .001). Similar rates of enrollment and reductions in BP and lipids were observed across different racial, ethnic, and primary language groups.
CONCLUSIONS AND RELEVANCE
The results of this study indicate that a standardized remote BP and cholesterol management program may help optimize guideline-directed therapy at scale, reduce cardiovascular risk, and minimize the need for in-person visits among diverse populations.
Additional Info
Disclosure statements are available on the authors' profiles:
Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network
JAMA Cardiol 2022 Nov 09;[EPub Ahead of Print], AJ Blood, CP Cannon, WJ Gordon, C Mailly, T MacLean, S Subramaniam, M Tucci, J Crossen, H Nichols, KB Wagholikar, D Zelle, M McPartlin, LS Matta, M Oates, S Aronson, S Murphy, A Landman, NDL Fisher, TA Gaziano, J Plutzky, BM SciricaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Despite decades of evidence, clear and consistent clinical practice guidelines, and an abundance, in most cases, of generic drug options, a substantial proportion of patients are not treated optimally for uncontrolled hypertension or cholesterol. There are many explanations for this failure in care delivery. Ultimately, the traditional care model that requires a physician and a patient to be together, face-to-face in a room, is inherently inadequate and untenable for population-level healthcare.
To overcome many of these barriers, we developed an entirely remote, nonlicensed navigator and advanced practice pharmacist–driven hypertension and lipid management program within our integrated health network and enrolled over 10,000 patients. Using standardized clinical and workflow algorithms, we were able to substantially lower blood pressure (by ~10 mm Hg) and LDL cholesterol levels (by ~38 mg/dL) in patients with established atherosclerotic cardiovascular disease or those at increased cardiovascular risk (eg, having diabetes, LDL cholesterol level >190 mg/dL). The results were even more remarkable in those patients who completed the entire program. Moreover, we saw similar benefits among multiple populations, including patients from traditionally underserved communities.
The challenge is how to scale and sustain population-level health programs that function in the background and thereby provide continuous, asynchronous longitudinal care. Unfortunately, incentives are not aligned, and the cost typically falls to providers and patients, who usually cannot support nontraditional programs. Moving to a more value-based care system will hopefully improve incentives for new care models. Still, until that happens, we must recognize the moral imperative. We all have to advocate for solutions that can deliver the care that we know saves lives.