Remotely-delivered algorithmic care pathways reduce key cardiovascular risk factors.

Key Points

• The rates of control of key cardiovascular conditions like hypertension and hyperlipidemia remain low (~50%) across the US, even if these conditions could be easily addressed through generic, guideline-directed, and cost-effective medications.
• A remote program les by patient navigators can deliver algorithmic care pathways to reach a diverse patient population and achieve control of key cardiovascular conditions through rapid initiation and intensification of guideline-directed medications.
• On a cohort of 10,000 patients, the Brigham and Women’s Cardiovascular Innovation Team was able to demonstrate a statistically significant and clinically meaningful reduction of both systolic and diastolic blood pressure as well as LDL cholesterol, through effective intensification of medical therapy.

Despite the clearly established link between hypertension and cardiovascular deaths, the rates of hypertension detection, treatment initiation, and level of control remain quite low around the globe and in the US, where just over 50% of patients routinely achieve blood pressure control. Similar patterns apply to hyperlipidemia, despite the fact that, for both conditions, the medical treatments are generic, guideline-directed, and cost-effective. Many factors limit control of cardiovascular risk factors, ranging from system-level issues such as access to health care, to individual-level issues such as prescribing inertia by clinicians.

Since 2018, the Brigham and Women’s Cardiovascular Innovation Team has been developing and implementing a remote program that leverages patient navigators to deliver algorithmic care pathways that can help initiate and titrate medical therapy to achieve rapid control of key cardiovascular conditions such as hypertension and hyperlipidemia. Their first pilot study employed an evidence-based automatic algorithm on a prospective cohort of 130 patients with hypertension, through which patients achieved blood pressure within 7 weeks. More recently, their first interim report on 5,000 patients managed via remote algorithmic care pathways demonstrated significant reductions in blood pressure and LDL cholesterol.

During the 2021 American Heart Association Scientific Sessions, Dr. Alexander Blood (Brigham and Women’s Hospital, Boston, Massachusetts) presented the results on the full cohort of 10,000 patients enrolled to date through the Mass General Brigham network. These patients were screened and identified based on their elevated blood pressure and LDL cholesterol – from an initial sample of 28,473 patients screened, 9,547 were enrolled in either the lipid or hypertension program. They represented a diverse patient population, with 12% above 75 year old, 55% female, and 30% identifying as non-White. Compared to their baseline before enrollment, patients in the program demonstrated a significant and clinically meaningful reduction by 10 mm Hg in their systolic blood pressure, by 6 mm Hg in their diastolic blood pressure and by 45 mg/dL in their LDL cholesterol. These clinical improvements were even larger among patients who achieved maintenance in the program, and were equally distributed across the spectrum of race and ethnicity. While all patients were also offered education on lifestyle modifications, these results were primarily achieved through effective intensification of medical therapy: for example, the proportion of patients taking guideline-recommended therapies like high-intensity statins increased from 40 to 55%.

In conclusion, the data presented so far by the Brigham and Women’s Cardiovascular Innovation Team has de

monstrated the clinically significant results that can be achieved via remote healthcare delivery, and its potential to reduce health inequities in access to care, initiation and maintenance on guideline-recommended medical therapy for key cardiovascular conditions like hypertension and hyperlipidemia.