Telemedicine in Cardiology

1
(No Transcript)
2
Internet-based Telemedicine for Cardiovascular
Disease Management

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

3
Why Telemedicine?

• Shift in incidence from acute to chronic disease
• Heart Failure
• Hypertension
• Diabetes
• Respiratory Disease
• Renal Disease

4
New Concepts
Toward a National Health Information
Infrastructure June 2000 National Committee
on Vital and Health Statistics

5
Heart Failure Demographics

• Heart Failure patients

The graph shows an increasing incidence of heart
failure patients from 1970 to 2040
6
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.
7
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.
8
Telehealth System
The diagram shows the connections between the
patient, provider and information database via
the internet for communications.
9
Patient Management
The figure shows a screen from the Internet
communication system used for hypertension
management
10
Patient Management

• Graphics

The figure shows a screen from the Internet
communication system used for hypertension
management
11
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
12
CVD Risk

• High in Underserved populations
• Inadequate care availability
• Inadequate health education
• The Medical Divide
• Increased Obesity/Metabolic Syndrome

13
CVD Risk Management

• Record Risk Factors

The figure shows a web screen used for
cardiovascular risk management
14
Patient Management

• Make a personal Health file

The figure shows a web screen used for
cardiovascular risk management
15
Patient Management

• Provide longitudinal feedback

The figure shows a web screen used for
cardiovascular risk management
16
Patient management

• Provide education

The figure shows a web screen used for
cardiovascular risk management
17
Risk Factors

• Rural vs. Urban

This slide shows the distribution of risk factors
in urban and rural subjects
18
Health Knowledge
This slide shows the health knowledge scores in
Urban and Rural subjects
19
Baseline data
20
Rural vs. Urban risk


This slide shows the improvement in risk factors
in urban and rural subjects
21
Clinical vs. Telemedicine

• Blood Lipids

This slide shows the changes in blood lipids in
subjects using the telemedicine system compared
to a control group
22
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
23
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
24
Clinical vs. Telemedicine


This slide shows the changes in CVD risk score in
subjects using the telemedicine system compared
to a control group
25
Telemedicine Use
22 of the clinical group monitored health status
26
Managing Hypertension

• Over 65 million patients
• Most not at goal BP
• Problem with medication adherence
• Increased risk
• Heart disease
• Stroke
• Renal failure

27
Patient Centered Therapy

• Knowledge
• Goal BP (guideline-based)
• Lifestyle effects
• Diet effects
• Medication effects
• Surveillance
• Self measured BP
• Weekly reporting
• Communication
• Internet
• Telephone

28
Patient Centered Therapy

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

29
Internet Use
This slide shows a web screen used for our
Internet-based hypertension management system
30
Internet Use
This slide shows a web screen used for our
Internet-based hypertension management system
31
Information Infrastructure
INFORMATION CENTER
This slide shows the new configuration of our
Internet-based hypertension management system,
and future concepts for health information
32
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

33
(No Transcript)