scholarly journals A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study (Preprint)

2019 ◽  
Author(s):  
Himali Weerahandi ◽  
Soaptarshi Paul ◽  
Lisa M Quintiliani ◽  
Sara Chokshi ◽  
Devin M Mann
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Mobile Health ◽  
Dietary Assessment ◽  
Mobile App ◽  
Healthy Behaviors ◽  
Phone Calls ◽  
Coaching Intervention ◽  
The Mean ◽  
Physiological Outcomes

BACKGROUND The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. OBJECTIVE This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. METHODS We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. RESULTS A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (<i>P</i>&gt;.10 for all parameters). CONCLUSIONS In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes.

scholarly journals A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study

10.2196/13989 ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. e13989
Author(s):  
Himali Weerahandi ◽  
Soaptarshi Paul ◽  
Lisa M Quintiliani ◽  
Sara Chokshi ◽  
Devin M Mann
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Mobile Health ◽  
Dietary Assessment ◽  
Mobile App ◽  
Healthy Behaviors ◽  
Phone Calls ◽  
Coaching Intervention ◽  
The Mean ◽  
Physiological Outcomes

Background The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes.

Abstract 15974: Non-Invasive Myocardial Work Indices in Normal Adolescents: A Pilot Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah Pradhan ◽  
Anna Mullikin ◽  
Vien T Truong ◽  
Wojciech Mazur ◽  
Michael D Taylor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Normal Values ◽  
Global Longitudinal Strain ◽  
Lv Function ◽  
Healthy Adolescent ◽  
Non Invasive ◽  
Work Index ◽  
The Mean ◽  
Global Work

Introduction: Myocardial work may provide a different perspective on LV function and energy consumption. Its non-invasive assessment by echocardiography correlates with invasive measures and there are normal values established in adult patients. We aimed to establish normal values in a healthy adolescent population. Methods: Nineteen healthy subjects (mean age = 15 ± 2 years, 42% male) with normal echocardiograms were prospectively included. Brachial cuff blood pressure was obtained immediately following apical images in the supine position. Post-processing of echocardiograms with speckle tracking echocardiography and derivation of global myocardial work indices from LV pressure-strain loops was done using EchoPAC (General Electric, v203R73.0) (Figure 1). Results: Baseline demographics, echocardiographic measures and global myocardial work indices are reported in Table 1. The mean global work index is 1833 ± 278 mmHg with mean global work efficiency of 95 ± 1.3%. No gender difference in myocardial work indices are found (p>0.05 for all). Correlation between global work indices with age, systolic blood pressure, LV ejection fraction, and global longitudinal strain (GLS) are presented in Table 2. Conclusions: This is a pilot study to begin establishing normal adolescent indices of non-invasive myocardial work. Figure 1. Example

scholarly journals P042: Pilot study for the inter-arm blood pressure systematic measurement during the diagnosis of transient ischemic attack in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S78
Author(s):  
P. La Rochelle ◽  
S. Lavoie ◽  
V. Boucher ◽  
M. Émond ◽  
J. Perry
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Pilot Study ◽  
Transient Ischemic Attack ◽  
Systematic Measurement ◽  
P Value ◽  
Systemic Thrombolysis ◽  
The Mean ◽  
Mild Stroke ◽  
Ischemic Attack

Introduction: Our principal aim was to document the feasibility of the systematic measurement of the inter-arm blood pressure difference (IABPD) during an episode of transient ischemic attack (TIA) or mild stroke diagnosed in the Emergency Department (ED). As secondary goal was to compare the systolic blood pressure (BP) at triage with the systolic BPs measured during the IABPD. Methods: This is a single center pilot study. Patients presenting in the ED for a diagnosis of TIA were recruited. Once patient has been triaged and diagnosed of TIA, a research assistant made sure that the patient lay on a stretcher for at least 5 minutes. Two automated sphygmomanometers were applied, on each arm. No specific device or device calibration were required. Three consecutive simultaneous BP readings were performed, inverting cuffs arm to arm between each reading. Only the last two set of readings were used to calculate the mean IABPD. This method enables to minimize the error coming from the potential sphygmomanometers’ inaccuracies. Results: 32 patients were recruited from June to September 2017 and all had a successful IABPD measurement. Four patients had an IABPD &gt;10 mmHg, varying from 1.5 to 13 mmHg when the left arm was higher and from 1 to 61 mmHg when the right arm was higher. Of the 22 patients where the triage BP arm side selection was recorded, only 11 were congruent with the arm presenting the highest BP during the IABPD measurement. Selecting of the arm with the highest BP value may better reflect cerebrovascular risk exposition. The mean systolic BP at triage was 159.3 mmHg (95%CI: 144.9-173.7) compared to144.8 mmHg (95%CI: 132.9-156.7) if the arm with the highest value during the IABPD measurement is selected and 142.4 mmHg (95%CI: 130.8-154.0) if the same arm as triage is selected. The p-value for these differences were 0.003 and 0.001 respectively. The patient which presented the IABPD of 61 mmHg, had a stroke 3 days after its ED visit which subsequently led to her death 10 days later. Conclusion: Our results show that the systematic IABPD measurement using a pragmatic approach in the ED is feasible and is ready to investigate its use in the context of a new TIA or mild stroke. This information may contribute to a better discrimination of the short-term risk of stroke and may help to diagnose acute aortic dissection, monitor more accurately BP during hyperacute stroke or estimate intracerebral hemorrhage risk if systemic thrombolysis is considered.

scholarly journals Effect of Ice Massage to Head and Spine on Blood Pressure and Heart Rate Variability in Patients with Hypertension: a Pilot Study

2021 ◽  
Vol 14 (3) ◽  
pp. 22-26
Author(s):  
Mooventhan A, MD ◽  
Sneha Bharati, BNYS ◽  
Nivethitha L, PhD ◽  
Manjunath NK, PhD
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Standard Deviation ◽  
Pilot Study ◽  
Systolic Blood Pressure ◽  
Reduce Blood Pressure ◽  
Clinical Impact ◽  
The Common ◽  
The Mean

Background: Ice massage is one of the common hydrotherapeutic procedures. The current study is first of its kind, conducted to evaluate the effect of ice massage to head and spine on blood pressure and heart rate variability in patients with hypertension. Materials and Methods: Fifteen hypertensive subjects with the mean ± standard deviation (SD) age of 48.87 ± 11.17 yrs were recruited and underwent only one session of ice massage to head and spine for 20 min. Blood pressure and heart rate variability were assessed before and immediately after the intervention. Results: Results of this study showed a significant reduction in systolic blood pressure (p = <.001), diastolic blood pressure (p < .001) and heart rate (p = .012), and a significant increase in R-R Interval (the intervals between adjacent R waves in the electro cardiogram) (p = .001) in the posttest assessments compared to its respective pre-test assessments. Conclusion: Results suggest that 20 min of ice massage to head and spine may reduce blood pressure and heart rate in patients with hypertension. However, there is no evidence that this provides any significant clinical impact for the patient.

scholarly journals A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App (Preprint)

2019 ◽  
Author(s):  
Florian Dittrich ◽  
David Alexander Back ◽  
Anna Katharina Harren ◽  
Marcus Jäger ◽  
Stefan Landgraeber ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Mobile Health ◽  
Interrater Reliability ◽  
Development Process ◽  
Rating Scale ◽  
Mobile App ◽  
Ankle Sprains ◽  
Rehabilitation Programs ◽  
Medical App ◽  
The Mean

BACKGROUND Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. OBJECTIVE In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. METHODS The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). RESULTS A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). CONCLUSIONS The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.

scholarly journals A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App

10.2196/16403 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16403
Author(s):  
Florian Dittrich ◽  
David Alexander Back ◽  
Anna Katharina Harren ◽  
Marcus Jäger ◽  
Stefan Landgraeber ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Mobile Health ◽  
Interrater Reliability ◽  
Development Process ◽  
Rating Scale ◽  
Mobile App ◽  
Ankle Sprains ◽  
Rehabilitation Programs ◽  
Medical App ◽  
The Mean

Background Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.

Abstract 04: Validation of the Instant Blood Pressure Smartphone Application (App)

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Timothy B Plante ◽  
Bruno Urrea ◽  
Zane T MacFarlane ◽  
Roger S Blumenthal ◽  
Edgar R Miller ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mobile Health ◽  
Smartphone Application ◽  
Smartphone Apps ◽  
Exclusion Criteria ◽  
Standard Device ◽  
The Us ◽  
Treatment Of Hypertension ◽  
The Mean ◽  
Low Sensitivity

Introduction: Mobile health (‘mHealth’) technologies include unregulated smartphone apps. Instant Blood Pressure (IBP; AuraLife, Newport Beach, CA) estimates blood pressure (BP) using the integrated sensors in the phone, without requiring a cuff. For 392 days in 2014-15, it was a top 50 best-selling iPhone app in the US (requiring ≥950 copies sold on those days). App store reviews document use of the app for treatment of hypertension. IBP has not been independently validated. Hypothesis: The absolute mean difference (MD) between IBP and a standard device will be ≤5.0 mmHg for systolic and diastolic BP measurements. Methods: Between Jul. and Sep. 2015, we enrolled adults age ≥18 yrs old, at Johns Hopkins clinics. Exclusion criteria were an active arrhythmia, internal device, or contraindication for arm BP measurement. Two order-randomized measurements were taken on two devices: IBP and a validated standard device (Omron-907). Each IBP measurement was compared to the average of the standard measurements. SBP and DBP MD were log transformed and T-tests were used to compare MD and the cutoff of ≤5.0 mmHg. Results: Of 85 participants, 52% (44 of 85) were women, mean ± SD age was 57 ± 16 years, and mean BMI was 28 ± 6 kg/m2; 53% (45 of 85) had hypertension. The mean ± SD absolute BP differences (IBP minus standard) were 12.4 ± 10.5 mmHg for systolic (P<0.001) and 10.1 ± 8.1 mmHg for diastolic BP (P<0.001). The app overestimated low BP and underestimated high BP (Figure). Sensitivity and specificity for hypertensive measurements (systolic ≥140 or diastolic ≥90 mmHg) were 0.2 and 0.9. Conclusions: BP measurements from an unregulated mHealth app with >148,000 units sold were highly inaccurate. The low sensitivity for hypertensive readings means that four-fifths of individuals with hypertensive BP levels will be falsely reassured that their BP is in the non-hypertensive range.

scholarly journals Enhanced Self-Efficacy and Behavioral Changes Among Patients With Diabetes: Cloud-Based Mobile Health Platform and Mobile App Service (Preprint)

2018 ◽  
Author(s):  
Dyna YP Chao ◽  
Tom MY Lin ◽  
Wen-Ya Ma
Keyword(s):  
Blood Pressure ◽  
Health Promotion ◽  
Mobile Health ◽  
Self Efficacy ◽  
Compliance Rate ◽  
Mobile App ◽  
Behavioral Changes ◽  
Self Management ◽  
Patient Centered ◽  
Individual Health

BACKGROUND The prevalence of chronic disease is increasing rapidly. Health promotion models have shifted toward patient-centered care and self-efficacy. Devices and mobile app in the Internet of Things (IoT) have become critical self-management tools for collecting and analyzing personal data to improve individual health outcomes. However, the precise effects of Web-based interventions on self-efficacy and the related motivation factors behind individuals’ behavioral changes have not been determined. OBJECTIVE The objective of this study was to gain insight into patients' self-efficacy with newly diagnosed diabetes (type 2 diabetes mellitus) and analyze the association of patient-centered health promotion behavior and to examine the implications of the results for IoT and mobile health mobile app features. METHODS The study used data from the electronic health database (n=3128). An experimental design (n=121) and randomized controlled trials were employed to determine patient preferences in the health promotion program (n=62) and mobile self-management education (n=28). The transtheoretical model was used as a framework for observing self-management behavior for the improvement of individual health, and the theory of planned behavior was used to evaluate personal goals, execution, outcome, and personal preferences. A mobile app was used to determine individualized health promotion interventions and to apply these interventions to improve patients’ self-management and self-efficacy. RESULTS Mobile questionnaires were administered for pre- and postintervention assessment through mobile app. A dynamic questionnaire allocation method was used to follow up and monitor patient behavioral changes in the subsequent 6 to 18 months. Participants at a high risk of problems related to blood pressure (systolic blood pressure ≥120 mm Hg) and body mass index (≥23 kg/m2) indicated high motivation to change and to achieve high scores in the self-care knowledge assessment (n=49, 95% CI −0.26% to −0.24%, P=.052). The associated clinical outcomes in the case group with the mobile-based intervention were slightly better than in the control group (glycated hemoglobin mean −1.25%, 95% CI 6.36 to 7.47, P=.002). In addition, 86% (42/49) of the participants improved their health knowledge through the mobile-based app and information and communications technology. The behavior-change compliance rate was higher among the women than among the men. In addition, the personal characteristics of steadiness and dominance corresponded with a higher compliance rate in the dietary and wellness intervention (83%, 81/98). Most participants (71%, 70/98) also increased their attention to healthy eating, being active, and monitoring their condition (30% 21/70, 21% 15/70, and 20% 14/70, respectively). CONCLUSIONS The overall compliance rate was discovered to be higher after the mobile app–based health intervention. Various intervention strategies based on patient characteristics, health care–related word-of-mouth communication, and social media may be used to increase self-efficacy and improve clinical outcomes. Additional research should be conducted to determine the most influential factors and the most effective adherence management techniques.

scholarly journals mHealth App for Patient Self-Management of Chronic Kidney Disease Improves Renal Outcome: Pilot Study (Preprint)

2018 ◽  
Author(s):  
Xuyong Chen ◽  
Shasha Xie ◽  
Xiaojuan Yu ◽  
Zhibin Chen ◽  
Min Zhuo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Mobile Application ◽  
Self Management ◽  
Control Group ◽  
The Mean ◽  
Physician Patient ◽  
Experimental Group

BACKGROUND The prevalence of chronic kidney disease (CKD) is approximately 850 million worldwide and 120 million in China. Approximately 2% of the CKD population will progress to end-stage renal disease (ESRD) requiring renal replacement therapy or transplantation. The total health care expenditure on dialysis for the entire ESRD population in China is estimated to be 240 billion RMB per year. Using mobile health information technologies to conduct low-cost, large-scale, and personalized populational health interventions show a great promise. OBJECTIVE In this pilot study, we assessed the feasibility and clinical effectiveness of a mobile application designed to improve patient's self-management of chronic kidney disease over a 3-month intervention with a pre-post design and a quasi-trial design. METHODS Patients with CKD stage 1-3 and uncontrolled proteinuria (proteinuria>1g per day) were recruited. Eligible patients who were waitlisted served as the control. Patients in the experiment group were invited to install a mobile application known as Shen Shang Xian (Chinese pinyin for kidney online) for CKD self-management. The enrollment included a questionnaire for medical history and self-reported objective physical parameters and laboratory values. Each participant was assigned to one nephrologist who communicated with the patient on an ad-hoc basis. Blood pressure and laboratory test results were entered by the patients on a regular basis. The application has a built-in clinical decision algorithm to generate health recommendations to users based on one's data-entry. The application also sends various alerts to patient's nephrologist for timely interventions. Blood pressure, proteinuria, serum creatinine and eGFR were measured before and after the management period. RESULTS Fifty-three patients were enrolled in the experimental group and 11 patients were in the control group. The average daily usage in minutes was 11.2 (25%-75% quartile [7.5, 16]) and the average of total physician-patient conversation was 116 (25%-75% quartile [51, 274]). There is a significant correlation between average daily usage and physician-patient conversation (R2=0.30, P<.001). The starting eGFR was 102 ml/1.73cm2 (95% CI 92-105]) in the experimental group and 118 ml/1.73cm2 (95% CI 100-134]) in the control group (P=.04). The body mass index (BMI), blood pressure, and proteinuria had no statistical significance. At the end of the study, the mean change of proteinuria was -1.39 g (95% CI -2.07 to -0.72]) in the experimental group and 0.37 g (95% CI -2.11-2.85]) in the control group (P=.14). After adjusted for ACEi/ARB use, the mean change of proteinuria was -1.46 vs 0.47 in the experimental group vs the control group respectively (P=.16). The eGFR was not changed at the end of the study. There was no correlation between the average daily use and change of proteinuria. CONCLUSIONS Participants used the mobile app on a daily basis and communicated with the nephrologists for their CKD management. Patients who used the CKD self-management app exhibited a non-statistically significant trend of proteinuria reduction after 3 months. This pilot study was underpowered and the follow-up period was short. A larger retrospective controlled trial is needed to confirm the effectiveness of mHealth app in CKD self-management.

Abstract P120: Feasibility Of An Asynchronous, Semi-Automated Remote Patient Monitoring Blood Pressure Management System

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Ashish Sarraju ◽  
Meg Babakhanian ◽  
Irvin Szeto ◽  
Clark Seninger ◽  
Tara I Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Patient Monitoring ◽  
The United States ◽  
User Feedback ◽  
Mobile App ◽  
Remote Patient Monitoring ◽  
Rpm System ◽  
Remote Patient ◽  
High Engagement

Introduction: While remote patient monitoring (RPM) for hypertension (HTN) continues to grow in the United States, most systems are third party, employer-directed, or do not directly lead to changes in medication management. Systems that address these issues may reduce therapeutic inertia and lead to more rapid control of blood pressure (BP). We developed a clinician-facing HTN RPM system with evidence-based customizable medication titration protocols that integrate with a patient mobile app and Bluetooth®-connected BP cuff. We report interim results from the pilot implementation of this system. Hypothesis: In a pilot study, an RPM system with patient and clinician-facing platforms and a semi-automated protocol will achieve high engagement with actionable user feedback. Methods: We performed a single arm, single center study with five clinicians from primary care (3) and cardiology (2). Eligible patients had essential hypertension (BP >130/80 mmHg) and a smartphone (iPhone, Android). Patients used a Bluetooth®-connected cuff that sent readings to a patient app and a clinician dashboard. Based on BP and comorbidities, a protocol provided medication titration recommendations for clinicians. In this 12-week study, we assessed feasibility through user feedback, user engagement (defined as the number of BP measurements), and changes in systolic (SBP, mmHg) and diastolic BP (DBP, mmHg). Results: We enrolled 18 patients (age 51 + 11y; 94% male; 29% White). Baseline SBP was 133 + 7.8 and DBP was 87 + 7.1. At a mean follow-up of 4.7 weeks, there were 15 + 11 weekly BP measurements per patient. Mean per-patient decreases in SBP and DBP were 12 (95% CI 5.8-18, p<0.001) and 7.1 (95% CI 3.1-11, p = 0.002), respectively. A total of 77.8% (14/18) patients continued BP measurements without attrition. Key feedback included improved cuff-mobile app connectivity (patients) and increased medication choices in protocols (clinicians). Conclusions: In interim results of a pilot study, an RPM HTN system was implemented with high engagement, evidence of BP reduction, and actionable feedback. Complete results including medication and BP changes are anticipated by September 2020 and will guide a planned, funded, large, multicenter cluster randomized trial.

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