internet-based telemedicine for cardiovascular disease management alfred a. bove, md, phd cardiology...
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![Page 1: Internet-based Telemedicine for Cardiovascular Disease Management Alfred A. Bove, MD, PhD Cardiology Section Temple University Medical Center](https://reader035.vdocuments.us/reader035/viewer/2022070403/56649f285503460f94c4082c/html5/thumbnails/1.jpg)
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Internet-based Telemedicine for Cardiovascular Disease Management
Alfred A. Bove, MD, PhD
Cardiology Section
Temple University Medical Center
![Page 3: Internet-based Telemedicine for Cardiovascular Disease Management Alfred A. Bove, MD, PhD Cardiology Section Temple University Medical Center](https://reader035.vdocuments.us/reader035/viewer/2022070403/56649f285503460f94c4082c/html5/thumbnails/3.jpg)
Why Telemedicine?
Shift in incidence from acute to chronic disease Heart Failure Hypertension Diabetes Respiratory Disease Renal Disease
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New Concepts
Toward a National Health Information Infrastructure
June 2000
National Committee on Vital and Health Statistics
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Heart Failure Demographics
Heart Failure patients
0
1
2
3
4
5
6
7
8
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
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Telephone Surveillance
0
10
20
30
40
50
60
70
80
90
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
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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.
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Patient Management
The figure shows a screen from the Internet communication system used for hypertension management
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0
50
100
150
200
250
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
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CVD Risk
High in Underserved populations Inadequate care availability Inadequate health education
• The “Medical Divide” Increased Obesity/Metabolic Syndrome
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CVD Risk Management
Record Risk Factors
The figure shows a web screen used for cardiovascular risk management
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Patient Management
Provide longitudinal feedback
The figure shows a web screen used for cardiovascular risk management
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Risk Factors
Rural vs. Urban
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Curr smoker Diabetes Htn Hyperlipid
TUMC
GMC
This slide shows the distribution of risk factors in urban and rural subjects
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Clinical vs. Telemedicine
Blood Lipids
*
*
*
*
This slide shows the changes in blood lipids in subjects using the telemedicine system compared to a control group
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Clinical vs. Telemedicine
Systolic Blood Pressure
Telemedicine
146 134
0
50
100
150
200
baseline finalm
mHg
Clinical
146 137
0
50
100
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
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Clinical vs. Telemedicine
120
125
130
135
140
145
150
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
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Clinical vs. TelemedicineCVD risk
17.8 17.515.1 15
5
10
15
20
25
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
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Managing Hypertension
Over 65 million patients Most not at goal BP Problem with medication adherence Increased risk:
Heart disease Stroke Renal failure
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Patient Centered Therapy Knowledge
Goal BP (guideline-based) Lifestyle effects Diet effects Medication effects
Surveillance Self measured BP Weekly reporting
Communication Internet Telephone
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Reporting Patient - monthly summaries via mail Physician - monthly summaries via fax
Quality Education BP goal Lifestyle changes Medication appropriateness
Patient Centered Therapy
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Internet Use
This slide shows a web screen used for our Internet-based hypertension management system
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Internet Use
This slide shows a web screen used for our Internet-based hypertension management system
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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
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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
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