Reducing cardiovascular disease risk in medically underserved urban and rural communities

• Published in: The American heart journal Vol. 161; no. 2; pp. 351 - 359
• Main Authors: Bove, Alfred A., MD, PhD, FACC, Santamore, William P., PhD, Homko, Carol, RN, PhD, Kashem, Abul, MD, PhD, Cross, Robert, MD, McConnell, Timothy R., PhD, Shirk, Gail, RN, Menapace, Francis, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2011; Mosby; Elsevier Limited
• Subjects: Atherosclerosis (general aspects, experimental research); Behavior; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - prevention & control; Cholesterol; Community centers; Diabetes; Female; Glucose; Humans; Hypertension; Internet access; Male; Medical sciences; Medically Underserved Area; Middle Aged; Mortality; Risk assessment; Risk Factors; Rural Health; Telemedicine; Triglycerides; Urban Health; Vascular disease; Rural environment; Urban environment; Heart disease; Atherosclerosis; Risk factor; Rural area; Cardiovascular disease; Urban area; Circulatory system; Cardiology; Community
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2010.11.008

Objectives The aim of this study is to evaluate methods for lowering cardiovascular disease (CVD) risk in asymptomatic urban and rural underserved subjects. Background Medically underserved populations are at increased CVD risk, and systems to lower CVD risk are needed. Nurse management (NM) and telemedicine (T) systems may provide low-cost solutions for this care. Methods We randomized 465 subjects without overt CVD, with Framingham CVD risk >10% to NM with 4 visits over 1 year, or NM plus T to facilitate weight, blood pressure (BP), and physical activity reporting. The study goal was to reduce CVD risk by 5%. Results Three hundred eighty-eight subjects completed the study. Cardiovascular disease risk fell by ≥5% in 32% of the NM group and 26% of the T group ( P , nonsignificant). In hyperlipidemic subjects, total cholesterol decreased (NM −21.9 ± 39.4, T −22.7 ± 41.3 mg/dL) significantly. In subjects with grade II hypertension (systolic BP ≥160 mm Hg, 24% of subjects), both NM and T groups had a similar BP response (average study BP: NM 147.4 ± 17.5, T 145.3. ± 18.4, P is nonsignificant), and for those with grade I hypertension (37% of subjects), T had a lower average study BP compared to NM (NM 140.4 ± 16.9, T 134.6 ± 15.0, P = .058). In subjects at high risk (Framingham score ≥20%), risk fell 6.0% ± 9.9%; in subjects at intermediate risk (Framingham score ≥10, <20), risk fell 1.3% ± 4.5% ( P < .001 compared to high-risk subjects). Medication adherence was similar in both high- and intermediate-risk subjects. Conclusions In 2 underserved populations, CVD risk was reduced by a nurse intervention; T did not add to the risk improvement. Reductions in BP and blood lipids occurred in both high- and intermediate-risk subjects with greatest reductions noted in the high-risk subjects. Frequent communication using a nurse intervention contributes to improved CVD risk in asymptomatic, underserved subjects with increased CVD risk. Telemedicine did not change the effectiveness of the nurse intervention.