Remotely delivered program improves blood pressure, cholesterol control in 5,000 patients

November 17, 2020

Boston, MA -- Despite being known risk factors for poor cardiovascular outcomes, blood pressure and low-density lipoprotein (LDL) cholesterol remain undertreated among a large proportion of patients. To address this gap, a team from Circulation.

"Our program demonstrates that we can remotely improve cardiovascular health through cholesterol and blood pressure control faster, more efficiently and with greater personalization than standard practice," said Scirica. "And we see this as a transferable program -- one that could be adopted in other health care settings. It could be applied to a broad range of clinical scenarios across our system and across the world, especially in places where health care resources may be scarce."

This report summarized the interim results of the first 5,000 Mass General Brigham patients with uncontrolled LDL cholesterol, blood pressure or both, who were enrolled between Jan. 1, 2018 and May 21, 2020. Patients were mostly prescribed lower-cost generic drugs through the program. Pharmacists initiated and adjusted prescriptions for individuals based on clinical algorithms, prescribing more intensive medications if a patient needed them or adjusting a dosage if a patient was initially intolerant to a medication.

Non-licensed navigators served as the face of the program. They communicated directly with patients, providing treatment recommendation and education until treatment goals were met. Digital tools helped support the workflow and clinical decisions for the navigators and pharmacists. The program was supervised by specialists, and primary care physicians were updated on all treatment changes.

Of the 3,939 patients in the Lipid program, 1,343 had achieved their goal LDL cholesterol level by the time of this report, with the average decrease in LDL cholesterol being 52 mg/dl (42 percent). An overall drop in cholesterol levels of 24 mg/dl (18 percent) was seen in all patients, including those still being actively managed. Of the 1,437 patients enrolled in the high blood pressure group, blood pressure levels dropped by an average of 14/6mmHg (systolic/diastolic) in the 556 who had completed the program by the time of this report.

"These reductions are clinically meaningful. From decades of studies, we know that reductions of this magnitude in blood pressure and cholesterol result in fewer heart attacks, strokes and other cardiovascular events," said Scirica.

Scirica notes that there are challenges in a program like this one, especially around keeping participants engaged. He also acknowledges that virtual care can amplify inequities in care. The team is working on multiple solutions to try to increase access, including low-tech solutions that rely on phone calls rather than video. They also continue to update and enhance the program as guidelines continue to evolve.

Still, the team hopes the work provides a foundation for future broadly delivered population health initiatives.

"I'm especially excited for the future of disease management programs that can help at the intersection of diseases," said Scirica. "We've started with lipids and hypertension first, but our interests expand to heart failure, diabetes, mental health -- all of which overlap -- and it motivates us to look into a fully integrated system for remote chronic care management."
-end-
Funding for this work was provided by Mass General Brigham and AllWaysHealth Partners.

Paper cited: Scirica BM, et al. "Digital Care Transformation: Interim Report from the First

5,000 Patients Enrolled in a Remote Algorithm-based Cardiovascular Risk Management Program to Improve Lipid and Hypertension Control" Circulation DOI: 10.1161/CIRCULATIONAHA.120.051913

Brigham Health, a global leader in creating a healthier world, consists of Brigham and Women's Hospital, Brigham and Women's Faulkner Hospital, the Brigham and Women's Physicians Organization and many related facilities and programs. With more than 1,000 inpatient beds, approximately 60,000 inpatient stays and 1.7 million outpatient encounters annually, Brigham Health's 1,200 physicians provide expert care in virtually every medical and surgical specialty to patients locally, regionally and around the world. An international leader in basic, clinical and translational research, Brigham Health has nearly 5,000 scientists, including physician-investigators, renowned biomedical researchers and faculty supported by over $700 million in funding. The Brigham's medical preeminence dates back to 1832, and now, with 19,000 employees, that rich history is the foundation for its commitment to research, innovation, and community. Boston-based Brigham and Women's Hospital is a teaching affiliate of Harvard Medical School and dedicated to educating and training the next generation of health care professionals. For more information, resources, and to follow us on social media, please visit
brighamandwomens.org.

Brigham and Women's Hospital

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