Internet-based Telemedicine for Cardiovascular Disease Management
Alfred A. Bove, MD, PhD
Cardiology Section
Temple University Medical Center
Why Telemedicine?
Shift in incidence from acute to chronic disease Heart Failure Hypertension Diabetes Respiratory Disease Renal Disease
New Concepts
Toward a National Health Information Infrastructure
June 2000
National Committee on Vital and Health Statistics
Heart Failure Demographics
Heart Failure patients
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Mil
lio
ns
1970 1980 1990 2000 2010 2020 2030 2040
The graph shows an increasing incidence of heart failure patients from 1970 to 2040
Telephone Surveillance
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Admissions ED visits
Usual careUC+Telephone
Chrysogelos E et.al . J Card Fail. 2000; 6:II-6. The graph shows a reduction in hospitalization and ED visits in heart failure patients using a telephone surveillance system.
47 pts20 mos
Telehealth System
Internet
Server/Database
ProviderWorkstation
Patient Webterminals
The diagram shows the connections between the patient, provider and information database via the internet for communications.
Patient Management
The figure shows a screen from the Internet communication system used for hypertension management
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Ho
spit
al D
ays
ControlTelemedicine
48 pts12 mos
P = 0.025
The graph shows a reduction in hospital days in patients with heart failure who used our Internet communication system. Kashem at al. J. Cardiac Failure 2008
CVD Risk
High in Underserved populations Inadequate care availability Inadequate health education
• The “Medical Divide” Increased Obesity/Metabolic Syndrome
CVD Risk Management
Record Risk Factors
The figure shows a web screen used for cardiovascular risk management
Patient Management
Provide longitudinal feedback
The figure shows a web screen used for cardiovascular risk management
Risk Factors
Rural vs. Urban
0%
10%
20%
30%
40%
50%
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90%
Curr smoker Diabetes Htn Hyperlipid
TUMC
GMC
This slide shows the distribution of risk factors in urban and rural subjects
Clinical vs. Telemedicine
Blood Lipids
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This slide shows the changes in blood lipids in subjects using the telemedicine system compared to a control group
Clinical vs. Telemedicine
Systolic Blood Pressure
Telemedicine
146 134
0
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150
200
baseline finalm
mHg
Clinical
146 137
0
50
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150
200
baseline final
mm
Hg
**
This slide shows the changes in systolic blood pressure in subjects using the telemedicine system compared to a control group
Clinical vs. Telemedicine
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1 2 3 4Visit Number
Systo
lic B
P m
mH
g
C
T
P = 0.03
This slide shows the time course of changes in systolic blood pressure over a one year period in subjects using the telemedicine system compared to a control group
Clinical vs. TelemedicineCVD risk
17.8 17.515.1 15
5
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30
Clinical Telemedicine
risk
%
baseline
final
**
This slide shows the changes in CVD risk score in subjects using the telemedicine system compared to a control group
Managing Hypertension
Over 65 million patients Most not at goal BP Problem with medication adherence Increased risk:
Heart disease Stroke Renal failure
Patient Centered Therapy Knowledge
Goal BP (guideline-based) Lifestyle effects Diet effects Medication effects
Surveillance Self measured BP Weekly reporting
Communication Internet Telephone
Reporting Patient - monthly summaries via mail Physician - monthly summaries via fax
Quality Education BP goal Lifestyle changes Medication appropriateness
Patient Centered Therapy
Internet Use
This slide shows a web screen used for our Internet-based hypertension management system
Internet Use
This slide shows a web screen used for our Internet-based hypertension management system
Information Infrastructure
INFORMATION CENTER
SERVER
PROVIDER
INTERNET
HOSPITAL
CLINIC
PATIENT
WIRELESS
PHARMACY
PATIENT
This slide shows the new configuration of our Internet-based hypertension management system, and future concepts for health information
What Works for Telemedicine Chronic Illness
Patient participation Care team includes the patient
Home monitored status Hypertension Heart Failure Diabetes COPD/Asthma
Easy Communication Expectation/empowerment