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远程心血管高血压项目在 COVID-19 大流行期间增强了血压控制。

Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID-19 Pandemic.

机构信息

Division of Cardiology, Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA.

Harvard Medical School Boston MA.

出版信息

J Am Heart Assoc. 2023 Mar 21;12(6):e027296. doi: 10.1161/JAHA.122.027296. Epub 2023 Mar 13.

Abstract

Background The COVID-19 pandemic disrupted traditional health care; one fallout was a drastic decrease in blood pressure (BP) assessment. We analyzed the pandemic's impact on our existing remote hypertension management program's effectiveness and adaptability. Methods and Results This retrospective observational analysis evaluated BP control in an entirely remote management program before and during the pandemic. A team of pharmacists, nurse practitioners, physicians, and nonlicensed navigators used an evidence-based clinical algorithm to optimize hypertensive treatment. The algorithm was adapted during the pandemic to simplify BP control. Overall, 1256 patients (605 enrolled in the 6 months before the pandemic shutdown in March 2020 and 651 in the 6 months after) were a median age of 63 years old, 57% female, and 38.2% non-White. Among enrolled patients with sustained hypertension, 51.1% reached BP goals. Within this group, rates of achieving goal BP improved to 94.6% during the pandemic from 75.8% prepandemic (<0.0001). Mean baseline home BP was 141.7/81.9 mm Hg during the pandemic and 139.8/82.2 prepandemic, and fell ≈16/9 mm Hg in both periods (<0.0001). Maintenance during the pandemic was achieved earlier (median 11.8 versus 19.6 weeks, <0.0001), with more frequent monthly calls (8.2 versus 3.1, <0.0001) and more monthly home BP recordings per patient (32.4 versus 18.9, <0.0001), compared with the prepandemic period. Conclusions A remote clinical management program was successfully adapted and delivered significant improvements in BP control and increased home BP monitoring despite a nationally observed disruption of traditional hypertension care. Such programs have the potential to transform hypertension management and care delivery.

摘要

背景

COVID-19 大流行扰乱了传统的医疗保健;其结果之一是血压(BP)评估大幅减少。我们分析了大流行对我们现有的远程高血压管理计划的有效性和适应性的影响。

方法和结果

本回顾性观察性分析评估了大流行前和大流行期间完全远程管理计划中 BP 控制情况。一组药剂师、执业护士、医生和非持照导航员使用基于证据的临床算法来优化高血压治疗。该算法在大流行期间进行了调整,以简化 BP 控制。总体而言,1256 名患者(605 名在 2020 年 3 月大流行关闭前的 6 个月内入组,651 名在之后的 6 个月内入组)的中位年龄为 63 岁,57%为女性,38.2%为非白人。在持续患有高血压的入组患者中,51.1%达到了 BP 目标。在这一组中,大流行期间达到目标 BP 的比例从大流行前的 75.8%提高到了 94.6%(<0.0001)。大流行期间的基线家庭 BP 平均为 141.7/81.9mmHg,大流行前为 139.8/82.2mmHg,两个时期均下降了约 16/9mmHg(<0.0001)。大流行期间的维持时间更早(中位数 11.8 周与 19.6 周,<0.0001),每月电话随访次数更多(8.2 次与 3.1 次,<0.0001),每个患者每月的家庭 BP 记录更多(32.4 次与 18.9 次,<0.0001)。

结论

尽管全国范围内传统高血压护理受到干扰,但远程临床管理计划成功适应并显著改善了 BP 控制,并增加了家庭 BP 监测。此类计划有可能改变高血压管理和护理提供方式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/affc/10111523/36cf1b25abf3/JAH3-12-e027296-g001.jpg

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