Telemedicine cardiovascular risk reduction in veterans: The CITIES trial.

Bosworth, Hayden B

Olsen, Maren K

McCant, Felicia

Stechuchak, Karen M

Danus, Susanne

Crowley, Matthew J

Goldstein, Karen M

Zullig, Leah L

Oddone, Eugene Z

2024-01-26T01:16:56Z

2024-01-26T01:16:56Z

2018-05

BACKGROUND:Comprehensive programs addressing tailored patient self-management and pharmacotherapy may reduce barriers to cardiovascular disease (CVD) risk reduction. METHODS:This is a 2-arm (clinical pharmacist specialist-delivered, telehealth intervention and education control) randomized controlled trial including Veterans with poorly controlled hypertension and/or hypercholesterolemia. Primary outcome was Framingham CVD risk score at 6 and 12 months, with systolic blood pressure; diastolic blood pressure; total cholesterol; low-density lipoprotein; high-density lipoprotein; body mass index; and, for those with diabetes, HbA1c as secondary outcomes. RESULTS:Among 428 Veterans, 50% were African American, 85% were men, and 33% had limited health literacy. Relative to the education control group, the clinical pharmacist specialist-delivered intervention did not show a reduction in CVD risk score at 6 months (-1.8, 95% CI -3.9 to 0.3; P = .10) or 12 months (-0.3, 95% CI -2.4 to 1.7; P = .74). No differences were seen in systolic blood pressure, diastolic blood pressure, or low-density lipoprotein at 6 or 12 months. We did observe a significant decline in total cholesterol at 6 months (-7.0, 95% CI -13.4 to -0.6; P = .03) in the intervention relative to education control group. Among patients in the intervention group, 34% received at least 5 of the 12 planned intervention calls and were considered "compliers." A sensitivity analysis of the "complier average causal effect" of intervention compared to control showed a mean difference in CVD risk score reduction of 5.7 (95% CI -12.0 to 0.7) at 6 months and -1.7 (95% CI -7.6 to 4.8) at 12 months. CONCLUSIONS:Despite increased access to pharmacist resources, we did not observe significant improvements in CVD risk for patients randomized to the intervention compared to education control over 12 months. However, the intervention may have positive impact among those who actively participate, particularly in the short term.

S0002-8703(18)30040-1

0002-8703

1097-6744

https://hdl.handle.net/10161/29884

eng

Elsevier BV

American heart journal

10.1016/j.ahj.2018.02.002

https://creativecommons.org/licenses/by-nc/4.0

Humans

Cardiovascular Diseases

Self Care

Risk Factors

Follow-Up Studies

Risk Reduction Behavior

Telemedicine

Blood Pressure

Time Factors

Adult

Middle Aged

Veterans

Female

Male

Patient Education as Topic

Telemedicine cardiovascular risk reduction in veterans: The CITIES trial.

Journal article

Bosworth, Hayden B|0000-0001-6188-9825

Olsen, Maren K|0000-0002-9540-2103

Crowley, Matthew J|0000-0002-6205-4536

Goldstein, Karen M|0000-0003-4419-5869

Zullig, Leah L|0000-0002-6638-409X

122

129

Duke

School of Medicine

Basic Science Departments

Clinical Science Departments

Institutes and Centers

Biostatistics & Bioinformatics

Medicine

Psychiatry & Behavioral Sciences

Medicine, Endocrinology, Metabolism, and Nutrition

Medicine, General Internal Medicine

Duke Cancer Institute

Duke Clinical Research Institute

Institutes and Provost's Academic Units

Center for the Study of Aging and Human Development

Initiatives

Duke Science & Society

Population Health Sciences

Duke Innovation & Entrepreneurship

Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences

Duke - Margolis Center For Health Policy

Biostatistics & Bioinformatics, Division of Biostatistics

Published

199