Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network

Abstract

ImportanceBlood pressure (BP) and cholesterol control remain challenging. Remote care can deliver more effective care outside of traditional clinician-patient settings but scaling and ensuring access to care among diverse populations remains elusive.ObjectiveTo implement and evaluate a remote hypertension and cholesterol management program across a diverse health care network.Design, Setting, and ParticipantsBetween January 2018 and July 2021, 20 454 patients in a large integrated health network were screened; 18 444 were approached, and 10 803 were enrolled in a comprehensive remote hypertension and cholesterol program (3658 patients with hypertension, 8103 patients with cholesterol, and 958 patients with both). A total of 1266 patients requested education only without medication titration. Enrolled patients received education, home BP device integration, and medication titration. Nonlicensed navigators and pharmacists, supported by cardiovascular clinicians, coordinated care using standardized algorithms, task management and automation software, and omnichannel communication. BP and laboratory test results were actively monitored.Main Outcomes and MeasuresChanges in BP and low-density lipoprotein cholesterol (LDL-C).ResultsThe mean (SD) age among 10 803 patients was 65 (11.4) years; 6009 participants (56%) were female; 1321 (12%) identified as Black, 1190 (11%) as Hispanic, 7758 (72%) as White, and 1727 (16%) as another or multiple races (including American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, unknown, other, and declined to respond; consolidated owing to small numbers); and 142 (11%) reported a preferred language other than English. A total of 424 482 BP readings and 139 263 laboratory reports were collected. In the hypertension program, the mean (SD) office BP prior to enrollment was 150/83 (18/10) mm Hg, and the mean (SD) home BP was 145/83 (20/12) mm Hg. For those engaged in remote medication management, the mean (SD) clinic BP 6 and 12 months after enrollment decreased by 8.7/3.8 (21.4/12.4) and 9.7/5.2 (22.2/12.6) mm Hg, respectively. In the education-only cohort, BP changed by a mean (SD) −1.5/−0.7 (23.0/11.1) and by +0.2/−1.9 (30.3/11.2) mm Hg, respectively (P < .001 for between cohort difference). In the lipids program, patients in remote medication management experienced a reduction in LDL-C by a mean (SD) 35.4 (43.1) and 37.5 (43.9) mg/dL at 6 and 12 months, respectively, while the education-only cohort experienced a mean (SD) reduction in LDL-C of 9.3 (34.3) and 10.2 (35.5) mg/dL at 6 and 12 months, respectively (P < .001). Similar rates of enrollment and reductions in BP and lipids were observed across different racial, ethnic, and primary language groups.Conclusions and RelevanceThe results of this study indicate that a standardized remote BP and cholesterol management program may help optimize guideline-directed therapy at scale, reduce cardiovascular risk, and minimize the need for in-person visits among diverse populations.

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“…6,7 In this issue of JAMA Cardiology, colleagues from Mass General Brigham hospital share their experience with implementing a comprehensive, multifaceted intervention to improve hypertension and lipid control across their entire health system. 8 Patients with elevated BP and/or low-density lipoprotein cholesterol were recruited, either through direct clinician referral or, more commonly, by identification from the EHR. The intervention itself was delivered by a patient navigator, a nonlicensed individual who followed care algorithms to titrate BP and lipid medications to goal while being supervised by a team of pharmacists, nurse practitioners, and physicians.…”

“…In this issue of JAMA Cardiology , colleagues from Mass General Brigham hospital share their experience with implementing a comprehensive, multifaceted intervention to improve hypertension and lipid control across their entire health system . Patients with elevated BP and/or low-density lipoprotein cholesterol were recruited, either through direct clinician referral or, more commonly, by identification from the EHR.…”