New program uses digital solutions to improve patients' blood pressure and cholesterol levels

New program uses digital solutions to improve patients' blood pressure and cholesterol levels

Heart disease is the leading cause of death in the United States and around the world. Lowering high blood pressure and cholesterol could help reduce morbidity and mortality, but frequent in-person visits to measure and manage these levels can be burdensome for patients. A team at Mass General Brigham implemented a telehealth program aimed at controlling patients' blood pressure and cholesterol levels. The new program leveraged digital solutions to reduce barriers to care, particularly in traditionally underserved patient populations. In a research study involving more than 10,000 participants in the Mass General Brigham system, researchers found that the program significantly reduced blood pressure and LDL cholesterol. The results are published in JAMA Cardiology.

Visiting an inpatient practice can be a great burden for patients with chronic illnesses or for people who live far away. We started this remote care program before the pandemic began. And when the pandemic began, we saw a significant increase in our enrollments and greater interest in the benefits of remote care. Patients want innovative solutions to make contact with the healthcare system easier. Our program provides strong evidence that remote care can work and change patients’ lives.”

Benjamin Scirica, MD, MPH, corresponding author, Division of Cardiovascular Medicine at Brigham and Women's Hospital, founding member of Mass General Brigham

Health care strategies and interventions to control hypertension and high cholesterol can vary widely in accessibility and quality, and these differences can exacerbate disparities in care. Previous studies have found that by age 55, 3 in 4 black adults have developed high blood pressure, compared with about half of white men and 40 percent of white women. Remote cardiovascular care programs have the potential to provide greater access to equitable, high-quality care.

Advances in healthcare technology have made it possible to offer patients many treatment options in their homes, rather than requiring doctor or hospital visits. The Hypertension and Cholesterol Optimization Program fits into Mass General Brigham's larger efforts to transform health care by helping patients access services and monitor health from home, especially at a time when hospital capacity is at a tipping point.

“This study is one of the largest, if not the largest, clinical implementation study in a healthcare network,” said lead author Alexander Blood, MD, MSc, also of the Division of Cardiovascular Medicine at the Brigham. "We meet patients where they are. We have communicated with them and shaped their health through the channels they prefer, including patient portals, SMS, email or phone calls. We envision adapting many more of our systems in the future to meet patient needs."

Over the past five years, Blood, Scirica and a team at Mass General Brigham have developed a series of remote chronic disease management programs. The programs, supervised by trained but unlicensed navigators and licensed pharmacists, are supported by the professional staff of the Mass General Brigham Health System. They use digital solutions such as digitally connected home blood pressure cuffs to adjust medication based on the patient's response to therapy.

To study the effectiveness of the intervention, the research team enrolled participants, provided training, and sent home blood pressure monitors that automatically sent blood pressure results back to the program. This program has been delivered to over 10,000 patients across dozens of clinics and hundreds of practices in the system.

Researchers found that with targeted planning and care, they were able to improve health outcomes, provide consistent care, and reach underserved populations. The team saw positive results, including reductions in high blood pressure and improvements in cholesterol levels in a large and diverse group of people. There were 8,103 participants in the lipid program and 3,658 participants in the hypertension program.

Over 424,000 blood pressure readings and 139,000 laboratory reports were collected through the program. The average reduction in systolic blood pressure was 9.7 mmHg in patients enrolled in the hypertension program, and the average reduction in cholesterol was 37 mmHg. Similar enrollment rates and reductions in blood pressure and cholesterol levels were observed across diverse racial, ethnic, and primary language populations.

Scirica explains that treating high blood pressure and high cholesterol could help reduce cardiovascular events such as heart attacks and strokes and reduce downstream healthcare costs, but future studies are needed to evaluate the financial impact of the program. As with many clinical programs, many patients did not fully complete the program -; 276 patients discontinued the hypertension program and 817 discontinued the lipid program. The team notes that further research is needed on engagement strategies, incentives and interventions to improve retention rates.

Overall, researchers concluded that the program successfully demonstrated a standardized, sustained, and remote approach to effectively lowering and maintaining improved blood pressure and cholesterol levels.

“When we look at clinical practice both locally and nationally, we see many patients who are not receiving the most advanced therapies,” Blood said. “We must initiate programs that produce solutions and overcome barriers for historically underserved patients.”

Source:

Brigham and Women's Hospital

Reference:

Blood, AJ, et al. (2022) Results of a Remote Hypertension and Lipid Program in More Than 10,000 Patients in a Diverse Health Care Network. JAMA Cardiology. doi.org/10.1001/jamacardio.2022.4018.

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