Telemedicine in Cardiology by fjwuxn

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									  Internet-based Telemedicine for
Cardiovascular Disease Management


    Alfred A. Bove, MD, PhD
       Cardiology Section
 Temple University Medical Center
Why Telemedicine?
   Shift in incidence from acute to chronic
    disease
     Heart Failure
     Hypertension

     Diabetes

     Respiratory Disease

     Renal Disease
New Concepts
 Toward a National Health Information
           Infrastructure

              June 2000

National Committee on Vital and Health
             Statistics
  Heart Failure Demographics
             Heart Failure patients
              8
              7

              6

              5
   Millions




              4
              3

              2

              1

              0
                  1970   1980   1990   2000   2010   2020   2030   2040

The graph shows an increasing incidence of heart failure patients from 1970 to 2040
Telephone Surveillance
     90
     80                          Usual care
     70                          UC+Telephone
     60
                                                          47 pts
     50
                                                          20 mos
     40
     30
     20
     10
      0
            Admissions           ED visits


 Chrysogelos E et.al . J Card Fail. 2000; 6:II-6. The graph shows a reduction in
 hospitalization and ED visits in heart failure patients using a telephone
 surveillance system.
Telehealth System

          Provider
         Workstation
                             Internet           Patient Web
                                                 terminals




         Server/Database

The diagram shows the connections between the patient, provider and
information database via the internet for communications.
Patient Management




The figure shows a screen from the Internet communication system used for
hypertension management
                  250                        Control
                                             Telemedicine
  Hospital Days




                  200                                              48 pts
                                                                   12 mos
                  150

                  100                              P = 0.025

                   50

                    0

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
CVD Risk
   High in Underserved populations
     Inadequate care availability
     Inadequate health education
        • The “Medical Divide”
       Increased Obesity/Metabolic Syndrome
CVD Risk Management
   Record Risk Factors




The figure shows a web screen used for cardiovascular risk management
Patient Management
   Provide longitudinal feedback




The figure shows a web screen used for cardiovascular risk management
Risk Factors
   Rural vs. Urban
               90%

               80%
                            TUMC
               70%
                            GMC
               60%

               50%

               40%

               30%

               20%

               10%

                0%
                      Curr smoker     Diabetes         Htn       Hyperlipid

This slide shows the distribution of risk factors in urban and rural subjects
         Clinical vs. Telemedicine
             Blood Lipids
                             Clinical                                              Telemedicine

        300                                                      300
                                            Baseline                                              Baseline
        250                                                      250
        200              *                  Final                200           *                  Final
mg/dl




                                                         mg/dl
        150                                                      150
        100                             *                        100
                                                                                           *
         50    203 192       121   114        47    49            50   199   190   120   114       47   47
          0                                                        0
                Chol           LDL             HDL                      Chol        LDL             HDL




         This slide shows the changes in blood lipids in subjects using the telemedicine system
         compared to a control group
       Clinical vs. Telemedicine
            Systolic Blood Pressure
                    Clinical                                                  Telemedicine
       200                                                      200

       150                                     *                150                                *




                                                         mmHg
mmHg




       100                                                      100

       50                                                       50                           134
                                       137                              146
                   146
        0                                                        0
                 baseline              final                          baseline               final




       This slide shows the changes in systolic blood pressure in subjects using the telemedicine
       system compared to a control group
Clinical vs. Telemedicine
                                150




                                145




                                140
             Systolic BP mmHg




                                135




                                130
                                                        C
                                                             P = 0.03

                                                        T
                                125




                                120
                                      1   2   Visit Number   3          4


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
Clinical vs. Telemedicine
                                    CVD risk

              30
                                        baseline

              25                        final
     risk %




              20
                                    *                             *
              15

              10
                     17.8    15.1                   17.5   15
              5
                       Clinical                    Telemedicine

This slide shows the changes in CVD risk score in subjects using the telemedicine system
compared to a control group
Managing Hypertension
   Over 65 million patients
   Most not at goal BP
   Problem with medication adherence
   Increased risk:
       Heart disease
       Stroke
       Renal failure
Patient Centered Therapy
       Knowledge
           Goal BP (guideline-based)
           Lifestyle effects
           Diet effects
           Medication effects
       Surveillance
           Self measured BP
           Weekly reporting
       Communication
           Internet
           Telephone
Patient Centered Therapy
   Reporting
       Patient - monthly summaries via mail
       Physician - monthly summaries via fax
   Quality
       Education
       BP goal
       Lifestyle changes
       Medication appropriateness
Internet Use




This slide shows a web screen used for our Internet-based hypertension management
system
Internet Use




This slide shows a web screen used for our Internet-based hypertension management
system
Information Infrastructure
           INFORMATION
              CENTER

                                       CLINIC
                                                             HOSPITAL



                                                                        PHARMACY

                   PATIENT

                                     INTERNET




                                                                            PATIENT

                   SERVER                                  WIRELESS



                                                PROVIDER


This slide shows the new configuration of our Internet-based hypertension management
system, and future concepts for health information
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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