Reducing CV Disease Risk in Medically Underserved Communities
Reducing CV Disease Risk in Medically Underserved Communities
Objectives The aim of this study is to evaluate methods for lowering cardiovascular disease (CVD) risk in asymptomatic urban and rural underserved subjects.
Background Medically underserved populations are at increased CVD risk, and systems to lower CVD risk are needed. Nurse management (NM) and telemedicine (T) systems may provide low-cost solutions for this care.
Methods We randomized 465 subjects without overt CVD, with Framingham CVD risk >10% to NM with 4 visits over 1 year, or NM plus T to facilitate weight, blood pressure (BP), and physical activity reporting. The study goal was to reduce CVD risk by 5%.
Results Three hundred eighty-eight subjects completed the study. Cardiovascular disease risk fell by ≥5% in 32% of the NM group and 26% of the T group (P, nonsignificant). In hyperlipidemic subjects, total cholesterol decreased (NM −21.9 ± 39.4, T −22.7 ± 41.3 mg/dL) significantly. In subjects with grade II hypertension (systolic BP ≥160 mm Hg, 24% of subjects), both NM and T groups had a similar BP response (average study BP: NM 147.4 ± 17.5, T 145.3. ± 18.4, P is nonsignificant), and for those with grade I hypertension (37% of subjects), T had a lower average study BP compared to NM (NM 140.4 ± 16.9, T 134.6 ± 15.0, P = .058). In subjects at high risk (Framingham score ≥20%), risk fell 6.0% ± 9.9%; in subjects at intermediate risk (Framingham score ≥10, <20), risk fell 1.3% ± 4.5% (P < .001 compared to high-risk subjects). Medication adherence was similar in both high- and intermediate-risk subjects.
Conclusions In 2 underserved populations, CVD risk was reduced by a nurse intervention; T did not add to the risk improvement. Reductions in BP and blood lipids occurred in both high- and intermediate-risk subjects with greatest reductions noted in the high-risk subjects. Frequent communication using a nurse intervention contributes to improved CVD risk in asymptomatic, underserved subjects with increased CVD risk. Telemedicine did not change the effectiveness of the nurse intervention.
Recent data have demonstrated a significant reduction in cardiovascular disease (CVD) mortality in part, related to more aggressive management of modifiable CVD risk factors. Although mortality from CVD is diminishing, ethnic minorities and medically underserved populations are at increased CVD risk because of a high prevalence of obesity with accompanying diabetes, hyperlipidemia, and hypertension.
Management of the presymptomatic phase of these disorders is best done by incorporating patient participation, improved health literacy, and monitoring of patient status through frequent communication between patient and health care provider. Nurse management (NM) has proven effective in improving diabetes, hyperlipidemia, and hypertension.
In this study, we compared an NM CVD risk reduction program to an NM system augmented with telemedicine (T) communication. The T system allowed subjects to report their weight, blood pressure (BP), and physical activity and to receive feedback regarding CVD risk management.
Abstract and Introduction
Abstract
Objectives The aim of this study is to evaluate methods for lowering cardiovascular disease (CVD) risk in asymptomatic urban and rural underserved subjects.
Background Medically underserved populations are at increased CVD risk, and systems to lower CVD risk are needed. Nurse management (NM) and telemedicine (T) systems may provide low-cost solutions for this care.
Methods We randomized 465 subjects without overt CVD, with Framingham CVD risk >10% to NM with 4 visits over 1 year, or NM plus T to facilitate weight, blood pressure (BP), and physical activity reporting. The study goal was to reduce CVD risk by 5%.
Results Three hundred eighty-eight subjects completed the study. Cardiovascular disease risk fell by ≥5% in 32% of the NM group and 26% of the T group (P, nonsignificant). In hyperlipidemic subjects, total cholesterol decreased (NM −21.9 ± 39.4, T −22.7 ± 41.3 mg/dL) significantly. In subjects with grade II hypertension (systolic BP ≥160 mm Hg, 24% of subjects), both NM and T groups had a similar BP response (average study BP: NM 147.4 ± 17.5, T 145.3. ± 18.4, P is nonsignificant), and for those with grade I hypertension (37% of subjects), T had a lower average study BP compared to NM (NM 140.4 ± 16.9, T 134.6 ± 15.0, P = .058). In subjects at high risk (Framingham score ≥20%), risk fell 6.0% ± 9.9%; in subjects at intermediate risk (Framingham score ≥10, <20), risk fell 1.3% ± 4.5% (P < .001 compared to high-risk subjects). Medication adherence was similar in both high- and intermediate-risk subjects.
Conclusions In 2 underserved populations, CVD risk was reduced by a nurse intervention; T did not add to the risk improvement. Reductions in BP and blood lipids occurred in both high- and intermediate-risk subjects with greatest reductions noted in the high-risk subjects. Frequent communication using a nurse intervention contributes to improved CVD risk in asymptomatic, underserved subjects with increased CVD risk. Telemedicine did not change the effectiveness of the nurse intervention.
Introduction
Recent data have demonstrated a significant reduction in cardiovascular disease (CVD) mortality in part, related to more aggressive management of modifiable CVD risk factors. Although mortality from CVD is diminishing, ethnic minorities and medically underserved populations are at increased CVD risk because of a high prevalence of obesity with accompanying diabetes, hyperlipidemia, and hypertension.
Management of the presymptomatic phase of these disorders is best done by incorporating patient participation, improved health literacy, and monitoring of patient status through frequent communication between patient and health care provider. Nurse management (NM) has proven effective in improving diabetes, hyperlipidemia, and hypertension.
In this study, we compared an NM CVD risk reduction program to an NM system augmented with telemedicine (T) communication. The T system allowed subjects to report their weight, blood pressure (BP), and physical activity and to receive feedback regarding CVD risk management.
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