Achieving the target blood pressure level at home as part of personalized remote monitoring
Authors:
Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
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Type: Original articles
DOI:
For citation: Shvartz V.A., Sokolskaya M.A. Achieving the target blood pressure level at home as part of personalized remote monitoring. Creative Cardiology. 2024; 18 (4): 437–446 (in Russ.). DOI: 10.24022/1997-3187-2024-18-4-437-446
Received / Accepted: 08.10.2024 / 28.11.2024
Keywords: arterial hypertension remote monitoring m-Health telemedicine cardiovascular surgery
Abstract
The purpose of this work – to assess the achievement of target blood pressure levels at home within the framework of the pilot study “Personalized remote monitoring of patients with cardiovascular pathology using modern information technologies”.
Materials and methods. The study included 50 patients, of whom 30 were men and 20 were women. The average age of the patients was 60±12 years. Patients used 3 personal digital devices at home: an ECG recorder, an automatic blood pressure monitor and a fitness bracelet for monitoring physical activity. Each device had its own smartphone application (on iOS or Android platforms), through which all measurement data was automatically sent to the server, where they were available at any time to the doctor through his personal account.
Results. The median follow-up was 29 (28; 31) months. During the first 12 months, 8 (16%) patients stopped being monitored. Baseline levels of SAD and DAD did not differ between the groups of patients who dropped out and patients who continued follow-up. The analysis of dynamics for different fractions of blood pressure levels showed statistically significant differences at different time points of the study. The median adherence across the cohort was 62 (40; 85)%. The group of patients with unsatisfactory adherence was statistically significantly more likely to have coronary heart disease, angina pectoris (myocardial infarction, coronary artery bypass grafting, percutaneous coronary interventions. Patients with cardiac arrhythmias and with surgical interventions for arrhythmias had significantly better adherence. The scores on the Morisky–Green test were higher in the group of satisfactorily committed: 2.7 (2; 4) points, versus 1.9 (1.5; 2.5) points in the group of unsatisfactorily committed.
Conclusion. Using self-measurement of blood pressure at home is an effective method in achieving target blood pressure levels. Comprehensive remote patient monitoring programs using multiple personal medical “assistants” have additional advantages because they lead to “synergy” type interaction, increasing the likelihood of using each other and increasing overall commitment. Validated questionnaires and psychological tests, screening evaluation and identification of insufficiently compliant patients in clinical practice are important.
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