Telemedicine in Cardiology

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Internet-based Telemedicine for Cardiovascular
Disease Management

• Alfred A. Bove, MD, PhD
• Cardiology Section
• Temple University Medical Center

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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

The graph shows an increasing incidence of heart
failure patients from 1970 to 2040
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HF Telephone Intervention
1518 pts 20 mos
P 0.69
P .005
Grancelli H, Varini S, Ferrante D, Schwartzman R,
Zambrano C, Soifer S, Nul D, Doval H GESICA
Investigators. J Card Fail. 2003 Jun9(3)172-9.
The graph shows a reduction in hospitalization
for heart failure in patients using a telephone
surveillance system.
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Telephone Surveillance
47 pts 20 mos
Chrysogelos E et.al . J Card Fail. 2000 6II-6.
The graph shows a reduction in hospitalization
and ED visits in heart failure patients using a
telephone surveillance system.
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Telehealth System
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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Patient Management

• Graphics

The figure shows a screen from the Internet
communication system used for hypertension
management
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48 pts 12 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

• Make a personal Health file

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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Patient management

• Provide education

The figure shows a web screen used for
cardiovascular risk management
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Risk Factors

• Rural vs. Urban

This slide shows the distribution of risk factors
in urban and rural subjects
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Health Knowledge
This slide shows the health knowledge scores in
Urban and Rural subjects
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Baseline data
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Rural vs. Urban risk


This slide shows the improvement in 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

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
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. Telemedicine


This slide shows the changes in CVD risk score in
subjects using the telemedicine system compared
to a control group
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Telemedicine Use
22 of the clinical group monitored health status
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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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Patient Centered Therapy

• Reporting
• Patient - monthly summaries via mail
• Physician - monthly summaries via fax
• Quality
• Education
• BP goal
• Lifestyle changes
• Medication appropriateness

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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
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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