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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 3, May/June 2021
128
AFRICA
Telemonitoring may cut heart attack, stroke by 50%: five-year study
People enrolled in a pharmacist-led telemonitoring
programme to control high blood pressure were about half
as likely to have a heart attack or stroke compared to those
who received routine primary care, according to research.
Researchers, led by study author Dr Karen L Margolis,
executive director of research at HealthPartners Institute
in Minneapolis, found that a heart attack, stroke, stent
placement or heart failure hospitalisation occurred in 5.3%
of the telemonitoring group versus 10.4% of the routine
primary-care group.
‘Home blood pressure monitoring linked with treatment
actions from the healthcare team delivered remotely
(telehealth support) in between office visits has been shown
to lower blood pressure more than routine care, and patients
really like it,’ said Margolis. ‘In addition, by avoiding serious
cardiovascular events over five years, our results indicate
significant cost savings.’ Patients reported that they liked
having support from a trusted professional, rapid feedback
and adjustments to their treatment, and having someone to
be accountable to.
Margolis reports that over five years, the savings
from reduced cardiovascular disease events exceeded the
telemonitoring intervention costs by $1 900 per patient.
‘The findings were just short of statistical significance,’ said
Margolis, ‘meaning they could have been due to chance.
However, we were surprised that the figures on serious
cardiovascular events pointed so strongly to a benefit of the
telemonitoring intervention,’ she said.
Uncontrolled high blood pressure is the largest modifiable
risk factor contributing to death from all causes. Nearly half
of US adults have high blood pressure, defined as equal to
or greater than 130 mmHg systolic, or 80 mmHg diastolic.
However, most adults with high blood pressure don’t have
their numbers under control.
Four hundred and fifty participants with uncontrolled
high blood pressure were enrolled in the study, conducted
at 16 primary-care clinics within the HealthPartners system
in Minnesota. Participants were blinded and randomised to
two groups: 222 patients were in the routine primary-care
group, and 228 in the telemonitoring group that also received
one year of remote care managed by a pharmacist. In the
telemonitoring group, patients were able to measure their
blood pressure at home and send it electronically to the
pharmacist, who then worked with them to make medication
and lifestyle changes in their treatment.
In clinic visits for all participants, researchers monitored
blood pressure at enrolment, six months, 12 months, 18
months and five years; kept track of any heart attacks, strokes,
coronary stents, heart failure hospitalisations and heart-
related deaths that occurred; and counted all the costs of their
blood pressure-related care and cardiovascular event care.
They found that in the telemonitoring group, there were
15 serious cardiovascular events (five non-fatal heart attacks,
four non-fatal strokes, five heart failure hospitalisations, one
cardiovascular death) among 10 patients. This group also had
two stent placements, making the total event rate 5.3%.
In the routine primary-care group, there were 26 serious
cardiovascular events (11 non-fatal heart attacks, 12
non-fatal strokes, three heart failure hospitalisations) among
19 patients. They also had 10 stent placements, making the
total event rate 10.4%.
Based on these findings, ‘widespread adoption of the
telemonitoring model might help US adults with uncontrolled
high blood pressure avoid serious cardiovascular events
and reduce healthcare costs,’ according to Margolis and
colleagues. They recommend future studies to figure out
how to increase the number of patients engaged in home
blood pressure monitoring over many years, and to measure
cardiovascular risk factors and cardiovascular events over
that extended period.
The study’s limitations are its relatively small size, and it
was at a single medical group’s urban and suburban primary-
care clinics, which may not represent the diversity of patients
who receive care in other settings across the country.
Source:
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