The reductions were "clinically meaningful" and of a magnitude that result in "fewer heart attacks, strokes and other cardiovascular events," Dr. Benjamin Scirica, cardiologist from Brigham and Women's Hospital, Boston, who led the team that developed the program, said in a news release.
Dr. Scirica described the program and early results during a November 17 media briefing at the virtual American Heart Association (AHA) scientific sessions. The results were simultaneously published in the journal Circulation.
The program relies on a team of patient navigators and pharmacists to help deliver personalized care remotely, without the need for in-person visits or clinician involvement in every treatment decision.
Between January 2018 and May 2020, the researchers screened 18,810 Mass General Brigham Health System patients and enrolled 5,000 (mean age, 64; 55% women) with uncontrolled LDL cholesterol and/or hypertension.
Through the program, patients were mostly prescribed lower-cost generic drugs to reduce cholesterol and/or blood pressure. Participating pharmacists started and adjusted medications for individuals based on clinical algorithms.
Among the 3,939 patients enrolled in the remote cholesterol management program, 1,343 (34%) have achieved their goal LDL cholesterol level thus far, with an average LDL-C decrease of 52 mg/dl (42%) in patients who completed the titration phase of the program. In all patients, there was an average overall 24 mg/dl decrease in LDL-C (18%) at the time of the data cut, Dr. Scirica reported.
Among the 1,437 patients enrolled in the hypertension program, blood pressure levels dropped by an average of 14 mmHg systolic and 6 mmHg diastolic in the 556 patients who completed initial titration.
Based on home BP monitoring data, average BP was 138/78 mm Hg at baseline and dropped to 124/72 mm Hg on average during the maintenance phase of the program.
"This blood pressure reduction was not only the result of up titration of existing medications but also the addition of medications," Dr. Scirica told the briefing.
"Our program demonstrates that we can remotely improve cardiovascular health through cholesterol and blood pressure control faster, more efficiently and with greater personalization than standard practice," Dr. Scirica added in the news release.
He and his colleagues see this type of remote disease management program working for other chronic diseases.
"We've started with lipids and hypertension first, but our interests expand to heart failure, diabetes, mental health - all of which overlap - and it motivates us to look into a fully integrated system for remote chronic care management," Dr. Scircia said in the release.
Commenting on this work at the briefing, Dr. Karen Joynt Maddox, from Washington University in St. Louis, said "the need for effective interventions for cardiovascular risk is huge."
This work, she added, demonstrates that "interventions using patient navigators and pharmacists are feasible" and the results are "very impressive. We need more research like this to really fine-tune our understanding of what works and what doesn't so that we can scale programs like this and optimize strategies."
Funding for this work was provided by Mass General Brigham and AllWays Health Partners. Dr. Scirica and several co-investigators have disclosed various relationships with industry.
SOURCE: https://bit.ly/32Yp1mB Circulation, online November 17, 2020.
By Megan Brooks
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