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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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

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ays

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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

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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

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baseline finalm

mHg

Clinical

146 137

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baseline final

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Hg

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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

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mH

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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

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Clinical Telemedicine

risk

%

baseline

final

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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