The algorithm-based program improves cholesterol and blood pressure levels

Reviewed by Emily Henderson, B.Sc.November 18, 2020

Using a remotely-delivered algorithm-based program for disease management, patients experienced significant improvement in cholesterol and blood pressure levels, according to the latest research presented today at the American Heart Association’s 2020 scientific sessions.

The virtual meeting will be held from Friday 13 November to Tuesday 17 November 2020 and is an important global exchange of the latest scientific advances, research and evidence-based clinical practice updates in cardiovascular science for healthcare. The manuscript of this study is published simultaneously today in Circulation, the flagship magazine of the American Heart Association.

Failure to properly treat hypercholesterolemia (high cholesterol) and hypertension (high blood pressure) remains an ongoing clinical challenge that increases the risk of heart attack, stroke, and cardiovascular death.

Using digital tools, physicians at Brigham and Women’s Hospital in Boston, Massachusetts, have initiated and continue to lead an algorithm-driven remote hypertension and hypertension management program.

Between January 2018 and May 2020, researchers screened 18,810 patients and enrolled 5,000 patients into the cholesterol program, the hypertension program, or both. Of the 3,939 patients enrolled in the cholesterol program, 35% had atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes but no ASCVD and 31% had low-density lipoprotein (LDL-C) cholesterol> 190 mg / dL.

Doctors, pharmacists, and care specialists helped design these management programs to initiate and adjust drug doses, also known as titration, to achieve maximum patient benefits while minimizing clinically important side effects.

“To better control cholesterol and blood pressure, which are both major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and the provision of care, including standardization of drug regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address limited access to physicians by expanding remote care. says study lead author Benjamin M. Scirica, MD, MPH, a cardiologist at Brigham and Women’s Hospital and an associate professor of medicine at Harvard School of Medicine, both in Boston.

Using electronic health records and medical references, the program identified people with uncontrolled LDL-C and / or hypertension. Patients received digitally connected blood pressure cuffs for use at home, while pharmacists and support staff used clinical algorithms to initiate and titrate medications at set intervals until treatment goals were met.

Findings from the study include:

• An overall reduction in LDL-C of 52 mg / dL (42%) occurred in patients who completed the titration phase of the program.

• Significant reductions in LDL-C were achieved in patients who met one of four cholesterol risk categories: established atherosclerotic cardiovascular disease, diabetes, severe hypercholesterolemia (LDL> 190 mg / dL), or high-risk primary prevention.

• The mean reduction in blood pressure was 14 mmHg systolic and 6 mmHg diastolic.
• An overall LDL-C reduction of 24 mg / dl (18%) was achieved in all enrolled patients.

This is an effective and efficient strategy for treating high-risk but undertreated patients and for optimizing guideline-directed therapy. Off-site specialist treatment for cholesterol and blood pressure control reduces the need for in-person visits and enables collaborative decision making in patient care. The results of our study provide a model for expanding remote health care delivery to increase access to care, to help reduce health inequalities and to improve the quality of health care. “

Benjamin M. Scirica, MD, MPH, lead author of the study and cardiologist at Brigham and Women’s Hospital, associate professor of medicine, Harvard School of Medicine