Remote risk management programme effective and efficient

A remote, algorithm-based programme to manage uncontrolled low-density lipoprotein (LDL) cholesterol and/or blood pressure is an effective and efficient way to optimise guideline-directed therapy across large populations, without the need for in-person visits [1].

The study results were presented by Prof. Benjamin Scirica (Brigham and Women's Hospital, USA) and simultaneously published in Circulation [1,2]. Prof. Scirica explained that undertreatment of hypercholesterolaemia and hypertension remains a problem. Thus, a remotely delivered, algorithmically-driven disease management programme was designed and implemented. In this programme, navigators and pharmacists, supported by specialists, initiated and titrated medications. Between January 2018 and May 2020, a total of 5,000 patients were enrolled in the cholesterol and hypertension programmes. During the COVID-19 pandemic, enrolment increased by nearly a quarter.

Among the 3,939 patients included in the cholesterol programme, 1,385 (35%) had established atherosclerotic cardiovascular disease (ASCVD); 995 (25%) had diabetes but no ASCVD; 1,247 (32%) had LDL cholesterol >190 mg/dL. In the group as a whole, an LDL cholesterol reduction of 24 mg/dl (18%) was achieved; in those who completed titration, it was 52 mg/dl (42%) (each P<0.001). The use of lipid-lowering therapy increased significantly.

The 1,437 patients in the hypertension programme achieved an average systolic and diastolic blood pressure reduction of 14 mmHg and 6 mmHg, respectively (each P<0.001). The percentage of patients on 1, 2, 3, or 4 antihypertensive medications changed from 42%, 25%, 7%, and 2% at baseline to 31%, 35%, 19%, and 5%, respectively, during maintenance (P<0.001). There were no serious adverse programme-related outcomes.

Prof. Scirica concluded that their programme provides a model for expanding remote healthcare delivery that may help to increase access to care, reduce health inequities, and improve healthcare quality.

 

1. 
   
   1. Scirica BM, et al. GLP1 RAs: The Clinical Trial Data. LBS.09, AHA Scientific Sessions 2020, 13–17 Nov.
   2. Scirica BM, et al. Circulation. 2020;142:00–00. Doi:10.1161/CIRCULATIONAHA.120.051913.

 



Posted on 17 February, 202125 March, 2024