Telemonitoring May Help To Reduce Heart Attack & Stroke Rate

Heart attack, stroke, stent placement, or heart failure hospitalization occurred in 5.3% of the telemonitoring group compared to 10.4% of the routine primary care group. Participants reported enjoying having the support of a trusted professional, rapid feedback and adjustments to treatments, along with having someone to be accountable to. 

Karen L. Margolis, M.D., M.P.H., executive director of research at HealthPartners Institute in Minneapolis and study author reports that over a period of 5 years the savings from the reduced cardiovascular disease events will exceed the telemonitoring intervention costs by $1,900 per patient. 

“Home blood pressure monitoring linked with treatment actions from the health care 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. In addition, by avoiding serious cardiovascular events over 5 years, our results indicate significant cost savings,” said Margolis. 

“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.

The largest modifiable risk factor contributing to death from all causes can be attributed to uncontrolled high blood pressure. Estimates are that nearly half of American adults have high blood pressure, which is defined as being equal to or greater than 130mm Hg systolic or 80mm Hg diastolic. Most people with high blood pressure may not be aware they are at risk for complications, and most with high blood pressure do not have their numbers under control. 

In this study conducted at 16 primary care clinics within the HealthPartners system in Minnesota, 450 participants with uncontrolled high blood pressure were enrolled who were blinded and randomly assigned to 2 groups: 228 in the telemonitoring group receiving 1 year of remote care managed by a pharmacist, and the control group of 222 who received routine primary care. 

Those in the telemonitoring group were able to measure blood pressure at home to electronically send to the pharmacist who would work with the patient to make changes in lifestyle and medication as required to their treatments. Clinic visits for all patients monitored blood pressure at the beginning of the study then again at 1 year, 1.5 years, and at 5 years keeping track of any heart attacks, strokes, coronary stents, heart failure hospitalizations, and any heart-related deaths. Additionally, all of the costs of blood pressure-related care and cardiovascular event care were recorded. 

5 non-fatal heart attacks, 4 non-fatal strokes, 5 heart failure hospitalizations, 1 CV death occurred for a total of 15 serious cardiovascular events among 10 patients in the telemonitoring group, which also had 3 stent placements bringing the total event rate to 5.3%. While in the routine primary care group 1 non-fatal heart attacks, 12 non-fatal strokes, 3 heart failure hospitalizations occurred for a total of 26 serious cardiovascular events among 19 patients, which also had 10 stent placements bringing the total event rate to 10.4%.

Based on these findings the authors write that "widespread adoption of the telemonitoring model might help U.S. adults with uncontrolled high blood pressure avoid serious cardiovascular events and reduce health care costs.”  The researchers recommend additional 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 was limited by the small size and being at a single medical group’s urban and suburban primary care clinics, as such this may not represent the diversity of those who receive care in other settings across the nation.