Remote BP, cholesterol management program may optimize guideline-directed therapy
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An all-remote hypertension and hypercholesterolemia management program with more than 10,000 participants was associated with significant decreases in BP and LDL at 6 and 12 months compared with education only, researchers reported.
“The current health care system is broken and for decades has failed to deliver effective, chronic CV care,” Benjamin M. Scirica, MD, MPH, associate professor of medicine at Harvard Medical School and director of quality initiatives at Brigham and Women’s Hospital’s cardiovascular division, told Healio. “We developed a methodology to create and implement scalable care programs that improve access to care and optimize CV treatments. It is a remotely delivered, pharmacist-driven, blood pressure and cholesterol management program. The study showed that the program can deliver high-quality care with clinically meaningful results that lower risk for CVD in a large, diverse patient population.”
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Scirica and colleagues analyzed data from 10,803 adults aged 26 to 80 years with elevated BP and/or LDL who were enrolled in a comprehensive remote hypertension and/or cholesterol program between January 2018 and July 2021. The mean age of participants was 65 years; 56% were women; 12% were Black, 11% were Hispanic and 11% reported a preferred language other than English. Among participants, 3,658 were enrolled in the hypertension program and 8,103 were enrolled in the lipids program.
Enrolled patients received education, home BP device integration and medication titration; however, 1,266 participants who declined home BP monitoring and program medication titration were enrolled in an education-only arm and received dietary, lifestyle and medication advice.
“Because the education-only cohort did not have any home BP readings, only office BP readings extracted from the electronic health record nearest the appropriate time points were used for this comparison for both groups,” the researchers wrote.
Nonlicensed navigators and pharmacists, supported by CV clinicians, coordinated care using standardized algorithms, task management and automation software. Researchers monitored BP and laboratory test results. The primary outcome was change in BP and LDL.
Researchers assessed 424,482 BP readings and 139,263 laboratory reports.
In the hypertension program, the mean office BP before enrollment was 150/83 mm Hg; mean home BP was 145/83 mm Hg.
For participants engaged in remote medication management, the mean clinic BP at 6 months and 12 months after enrollment decreased by –8.7/–3.8 mm Hg and –9.7/–5.2 mm Hg, respectively. In the education-only cohort, BP changed by a mean –1.5/–0.7 mm Hg at 6 months and by +0.2/1.9 mm Hg at 12 months (P for between-cohort difference, < .001).
In the lipid management program, participants in remote medication management experienced a mean reduction in LDL of –35.4 mg/dL and –37.5 mg/dL at 6 and 12 months, respectively, whereas the education-only cohort experienced a mean LDL reduction of –9.3 mg/dL and –10.2 mg/dL at 6 and 12 months, respectively (P < .001).
Results persisted in analyses stratified by race and primary language spoken.
“We need to continue to test different engagement and retention strategies in order to include more patients in these programs,” Scirica told Healio. “In addition, there are a variety of potential business models that need to be tested to determine the best ways to ensure the sustainability of these programs within the current health system.”
For more information:
Benjamin M. Scirica, MD, MPH, can be reached at bscirica@bwh.harvard.edu.
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