Remote program to improve lipid and hypertension management

AHA 2021 This remote hypertension and LDL-c management program enrolled over 10,000 patients at high CV risk. The program effectively improved hypertension and LDL-c control across a diverse health care network.

Presented at the American Heart Association’s Scientific Sessions 2021 by: Alexander J. Blood, MD -Boston, MA, USA.

Introduction and methods

Aim of the program

Hypertension and hypercholesterolemia remain undertreated. Remotely delivered healthcare could potentially engage more patients in a treatment program. However, there is also a concern of exacerbating health inequities with such an approach. Alexander J. Blood, MD presented the design and outcomes of an ongoing remotely delivered hypertension and hyperlipidemia management program.

Program design

Patients who were not at treatment goals for hypertension of hypercholesterolemia were identified by provider referral and electronic health record screening. The program was fully funded and patients could enroll into the program at no additional costs. The program screened 28473 patients and enrolled 10803 patients (55% female, 29% non-white, 8% non-English speaking). 1256 patients chose to participate only in the education part of the program and 9547 patients proceeded with medication management (6887 patients in the lipid program and 3367 in the hypertension program). All patients received dietary and lifestyle recommendations.

Patient navigators functioned as the primary contact person for patients. Navigators are non-licensed personnel who provide education and gather data through phone, text or email. Pharmacitst prescribe and up-titrate therapy as part of a Collaborative Drug Treatment Management program. Physicians can be contacted to support pharmacists when needed. Digital technology is used to integrate data from patients, devices, and the electronic health record. This technology thereby allows for the automation of workflow, streamlined communication, and decision guidance. BP values and lab results were monitored for safety.

Main results

• 40% of patients in the lipid program and 44% of patients in the hypertension program completed all steps to optimize therapy. These patients achieved -so called- maintenance. The proportion of patients who remained in active medication management after 3 months was 23% in the lipid program and 15% in the hypertension program. 37% and 41%, respectively, only completed partial therapy, became unreachable, withdrew, or were referred to a physician.
• Mean BP reduction between baseline and the end of the program (exit) was 10/6 mmHg in all enrolled patients in the hypertension program and 12/7 mmHg in patients who achieved maintenance (both P<0.0001).
• The BP results were also analyzed in selected populations (White, Black, other race, Hispanic, non-English speaking). BP was significantly reduced between baseline and exit among patients who reached maintenance in all investigated subgroups (all P<0.0001).
• Mean LDL-c reduction between baseline and exit was 45 mg/dL in all enrolled patients in the lipid program and 70 mg/dL in patients who achieved maintenance (both P<0.0001). This reduction was observed in all investigated subgroups (all P<0.0001).
• Prescription rates of lipid-lowering therapy at baseline and exit in patients who reached maintenance in the lipid program showed significant increases in high intensity statin, ezetimibe, and PCSK9i therapy. The proportion of patients who were not on lipid-lowering therapy was significantly reduced between baseline and exit.

Conclusion

Alexander J. Blood, MD summarized that this remote CV health program effectively improved hypertension and LDL-c control in high-risk patients. The observed benefits of the program were consistent across all subgroups. The results also re-affirm how difficult it is to maintain patients in longitudinal health care management.

-Our reporting is based on the information provided at the American Heart Association’s Scientific Sessions 2021-

Watch a video about this program