Factors affecting frequency of patient use of Internet-based telemedicine to manage cardiovascular disease risk.

We examined the frequency of use by patients of a web-based reporting system to monitor and control cardiovascular disease (CVD) risk factors. A total of 192 patients with intermediate or high CVD risk were categorized into four quartiles based on their frequency of use of the telemedicine reporting system over one year. The lowest frequency users (Quartile I) averaged 17 reporting days in one year and the highest frequency users (Quartile IV) averaged 211 reporting days in one year.

Managing hypertension in urban underserved subjects using telemedicine--a clinical trial.

Background: We evaluated an Internet- and telephone-based telemedicine system for reducing blood pressure (BP) in underserved subjects with hypertension.

Methods: A total of 241 patients with systolic BP ≥140 mm Hg were randomized to usual care (C; n = 121) or telemedicine (T; n = 120). The T group reported BP, heart rate, weight, steps/day, and tobacco use twice weekly.

Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus.

Background: Health information technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to examine the impact of an enhanced telemedicine system on glucose control and pregnancy outcomes in women with gestational diabetes mellitus (GDM).

Subjects And Methods: We used an Internet-based telemedicine system to also allow interactive voice response phone communication between patients and providers and to provide automated reminders to transmit data.

Treatment of patients with intermediate cardiovascular risk: Are clinical measures enough?

Aim: Clinical measures of cardiovascular disease risk (CVD) are important tools for establishing therapy to lower CVD risk. Risk assessment has come under criticism because clinical measures can underestimate or overestimate CVD risk. We assessed CVD risk in 252 subjects without evidence of CVD to establish therapy of one or more risk factors from clinical indications.

Reducing cardiovascular disease risk in medically underserved urban and rural communities.

Objectives: The aim of this study is to evaluate methods for lowering cardiovascular disease (CVD) risk in asymptomatic urban and rural underserved subjects.

Background: Medically underserved populations are at increased CVD risk, and systems to lower CVD risk are needed. Nurse management (NM) and telemedicine (T) systems may provide low-cost solutions for this care.

Rural and urban characteristics impact cardiovascular risk reduction.

Purpose: Our aim was to provide a descriptive analysis of specific differences between rural and urban residents and the interaction between these differences and those who reduced cardiovascular disease (CVD) risk in response to intervention versus those who did not.

Methods: This study is a descriptive analysis comparing rural groups with urban groups and those who decreased CVD risk with those who did not. Two hundred five rural (median age = 64.

Gender differences in cardiovascular risk factors and risk perception among individuals with diabetes.

Purpose: The purpose of this study was to examine gender-based differences in cardiovascular risk factors and risk perception among individuals with diabetes.

Methods: The sample consisted of patients with an established history of diabetes who were enrolled in a telemedicine trial to reduce cardiovascular disease (CVD) risk. All subjects had a 10% or greater risk on the Framingham risk index.

Cardiovascular disease knowledge and risk perception among underserved individuals at increased risk of cardiovascular disease.

Background: Cardiovascular disease (CVD) risk factor awareness and knowledge are believed to be prerequisites for adopting healthy lifestyle behaviors. The purpose of this study was to examine knowledge of CVD risk factors and risk perception among individuals with high CVD risk.

Methods: The sample consisted of inner city and rural medically underserved patients at high risk of CVD.

Accuracy of blood pressure measurements transmitted through a telemedicine system in underserved populations.

In underserved populations, inadequate surveillance and treatment allows hypertension to persist until actual cardiovascular events occur. Thus, we developed an Internet-based telemedicine system to address the suboptimal control of hypertension and other modifiable risk factors. To minimize cost, the subjects used home monitors for blood pressure (BP) measurements and entered these values into the telemedicine system.

Managing heart failure care using an internet-based telemedicine system.

Background: Managing patients with heart failure (HF) is labor intensive, and follow-up is often inadequate to detect day-to-day changes that ultimately lead to decompensation. We tested the effect of an Internet-based telemedicine (T) system that provides frequent surveillance and increased communicate between HF patients and their provider on frequency of hospitalization in a cohort of patients with advanced HF.

Methods And Results: HF patients in NYHA Class II-IV were randomized to usual care (UC, n = 24) or T (T plus UC, n = 24) and followed for 1 year.

Using a telemedicine system to decrease cardiovascular disease risk in an underserved population: design, use, and interim results.

Cardiovascular disease is the leading cause of morbidity and mortality in the USA. Disease management programs, while successful, are intensive and expensive. Follow-up is often inadequate, incomplete, and inconsistent.

Right atrial effects on right ventricular ejection fraction derived from thermodilution measurements.

Objective: The thermodilution technique provides a convenient means to monitor cardiac output, right ventricular (RV) ejection fraction (EF), and volumes at the bedside. To calculate RVEF from the pulmonary artery temperature curve, the bolus thermodilution technique assumes that right atrial (RA) temperature returns to baseline value within 1 beat following the cold saline injection. The authors hypothesized that this assumption is the reason why the thermodilution technique consistently underestimates RVEF.

Cardiovascular simulation toolbox.

A toolbox for Matlab Simulink (trademark of Mathworks corp. etc.) was developed to simulate various models of flow in the cardiovascular system and study effects of different pathological conditions.

Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus.

Background: Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the Internet.

Methods: Women with GDM were randomized to either the Internet group (n = 32) or the control group (n = 25).

Management of heart failure patients using telemedicine communication systems.

Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent communication is an important component of care. A variety of studies using the telephone to maintain communication have demonstrated reduced hospital admissions and improved morbidity rate.

Web-based Internet telemedicine management of patients with heart failure.

An Internet-based store-and-retrieval telemedicine system to communicate between patients and their healthcare provider was tested. The system requires no specialized equipment, is Web-based, and allows frequent surveillance of the health status of the patients with heart failure (HF). Thirty six patients were recruited to evaluate a Web-based telemedicine system for reducing care encounters.

Cardiovascular disease prevention for underserved patients using the Internet: bridging the digital divide.

For underserved populations, telemedicine can address the high prevalence and suboptimal control of cardiovascular disease (CVD) risk factors. However, Internet access issues may limit the successful application of telemedicine. We tested the hypothesis that computer skills, and not access per se, was the main obstacle to using the Internet for health care.

Early and late results of left ventricular reshaping by passive cardiac-support device in canine heart failure.

Background: We tested whether the CardioClasp, a passive non-blood-contacting device could decrease excessive geometric burden in dilated cardiomyopathy and improve left ventricular systolic function and contractility by reshaping the left ventricle (LV) and by decreasing LV wall stress (LVWS) without decreasing arterial blood pressure.

Methods: In mongrel dogs (n = 6, the early group; n = 6, the chronic group; 25-27 kg), 4 weeks of rapid right ventricular pacing (210 to 240 bpm) induced dilated cardiomyopathy with heart failure. In the early group, we used hemodynamic data and echocardiography to evaluate LV systolic function immediately after placing the CardioClasp device.

CardioClasp changes left ventricular shape acutely in enlarged canine heart.

Background: In dilated cardiomyopathy (DCM), eliminating or reducing extra-geometric burden to the myocardial cells would directly reduce myocardial wall stress leading to improved LV systolic performance. In acute experiments, we tested whether a passive non-blood contacting CardioClasp device, which employs two indenting bars to reshape the left ventricle (LV), could reduce extra-geometric burden, LV wall stress (LVWS) and improve LV systolic function and contractility without decreasing arterial blood pressure.

Methods: In mongrel dogs (n = 5), 4 weeks of right ventricular pacing (210-220-230-240 ppm) induced DCM with severe heart failure.

Left ventricular systolic performance in failing heart improved acutely by left ventricular reshaping.

Objective: If the geometric distortion during dilated heart failure could be corrected, the tension on the myocytes would be decreased, thereby leading to an improvement in left ventricular systolic function. We tested the effects of the CardioClasp (CardioClasp Inc, Pine Brook, NJ), a left ventricular reshaping device, on the failing heart, and our empirical data were compared with computationally derived data.

Methods: Heart failure was induced by 4-week rapid cardiac pacing.

Left ventricular reshaping: effects on the pressure-volume relationship.

Objective: We tested whether the CardioClasp device (CardioClasp, Inc, Cincinnati, Ohio), a non-blood contact device, would improve left ventricular contractility by acutely reshaping the left ventricle and reducing left ventricular wall stress.

Methods: In dogs (n = 6) 4 weeks of ventricular pacing (210-240 ppm) induced severe heart failure. Left ventricular function was evaluated before and after placement of the CardioClasp device, which uses 2 indenting bars to reshape the left ventricle.

CardioClasp: a new passive device to reshape cardiac enlargement.

In dilated heart failure, geometric distortions place an extra load on the myocardial cells. If this extra burden can be eliminated, the myocardial wall stress would decrease leading to improved systolic ventricular performance. In a dilated heart failure model, we wanted to see whether the CardioClasp (which uses two indenting bars to reshape the left ventricle [LV] as two widely communicating "lobes" of reduced radius) could improve systolic performance by passively reshaping the LV and reducing the wall stress.