An integrated approach for very high cardiovascular risk patients. Intermediate results

Abstract

The main objective of secondary prevention measures is to modify key risk factors such as hypertension (HTN) and dyslipidemia in patients with established cardiovascular diseases. Its proper implementation improves both short- and long-term outcomes. Telehealth technologies contributes to faster achievement of target levels and better control of key risk factors.Aim. To establish a comprehensive personalized follow-up framework for patients recovered from an acute coronary syndrome (ACS) that integrates telehealth software and to test its clinical and patient-centered efficacy.Material and methods. The three-month follow-up data of 50 patients (50% of planned enrollees; median age, 57 years [53; 61]; males, 84%) who suffered ACS with myocardial revascularization and low-density lipoprotein cholesterol (LDL-C) at least 2,5 mmol/L at admission. We introduced the simple and save telehealth software for home BP monitoring and lipid profiling. The basic demographic, clinical and laboratory characteristics of patients were described, as well as the changes lipid profile, office and home BP over this period was analyzed. The primary endpoint was a change in LDL-C after 3 months. In addition, we also focused on pharmacological therapy and its dynamics, as well as on remote counseling and patient’ experience with the mobile application.Results. Three months after inclusion, we have noted significant decrease of total cholesterol (-1,67 mmol/L, p<0,0001) and triglycerides (-0,48 mmol/L, p<0,0001). LDL-C changes were also significant (-1,49 mmol/L, adjusted for age, sex and lipid-lowering therapy; p<0,0001) and was associated only with the baseline LDL-C levels (R2=-0,521, p<0,0001). Thirty-nine (78%) patients achieved at least 1 mmol/L drop of LDL-C. Nine of them reached target LDL-C <1,4 mmol/L (and/or a decrease of 50% from baseline). Both high-density lipoprotein cholesterol (-0,48 mmol/l, p=0,348), office and home BP remained mostly unchanged. The proportion of patients with target office BP levels was almost the same (χ2=3,06, p=0,08). Patients who were recommended combined lipid-lowering therapy with cholesterol absorption inhibitor (ezetimibe) were more likely to achieve target LDL-C (χ2=10,95; p=0,003) than those with single agent (67% versus 17%, p=0,003). No differences were found in subgroups of patients in LDL-C reduction. In each patient an average of 15 remote consultations have been performed (from 1 to 54 per patient per 3 moths). Investigators have had to send reminders to 22 patients regarding the need for regular home BP monitoring. The majority of patients treated telehealth software as easy-to-use and user-friendly.Conclusion. According to the 3-month follow-up of patients after ACS who used the framework integrated with telemonitoring and remote counseling, a positive trend in reducing atherogenic lipid levels was demonstrated, but not in office BP. Only a fifth of patients reached the target LDL-C, but the vast majority had target BP. Despite the fact that the program is convenient to use, almost half of participants require additional reminders from physician on self-monitoring.

Integrated solution for patients of a very high cardiovascular risk. Final results

“…В практику врачей-кардиологов (исследователей) было интегрировано гибридное телемедицинское решение, реализованное на рабочих персональных компьютерах, с мобильным приложением (только для пациента). Функционал этого программного продукта был в подробностях описан ранее [13]. Необходимо особо отметить, что представлен он был разделом электронных дневников самоконтроля (ЭДС) АД, липидного спектра, а также дополнялся сервисом текстовых плановых консультаций (экстренные консультации исключены).…”

“…Пациентам предлагалось заполнить на первом и на заключительном визитах 2 опросника: 1) русскоязычный вариант опросника по качеству жизни для пациентов с ишемической болезнью сердца (ИБС) -HeartQol [14] и 2) специально разработанную для данного исследования "Анкету удовлетворенности программой" [13]. Кроме этого, на заключительном визите задавался дополнительный вопрос: "Насколько Вы готовы рекомендовать участие в программе другим людям, перенесшим такое же заболевание?"…”

“…Согласно ранее полученным результатам, небольшая доля изначально включенных 50 пациентов, с которыми был проведен промежуточный визит, достигла целевых значений ХС-ЛНП [13]. Столь же незначительна осталась эта группа и после завершения набора в исследование.…”