Design and rationale of penn medicine healthy heart, a randomized trial of effectiveness of a centrally organized approach to blood pressure and cholesterol improvement among patients at elevated risk of atherosclerotic cardiovascular disease
K.G. Volpp MD, PhD , K. Mahraj MSI , L.A. Norton MA, MBE , D.A. Asch MD, MBA , K. Glanz PhD, MPH , S.J. Mehta MD, MBA , M. Balasta MD , W. Kellum MD , J. Wood MD , L.B. Russell PhD , A.C. Fanaroff MD , S. Bakshi MD , D. Jacoby MD , J.B. Cohen MD, MSCE , M.J. Press MD , K. Clark MPH , J. Zhu MS, MBA , C. Rareside MS , L.E. Ashcraft PhD , C. Snider MPH , M.E. Putt PhD
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Abstract
Rationales
Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of morbidity and mortality in the United States. Suboptimal control of hypertension and hyperlipidemia are common factors contributing to ASCVD risk. The Penn Medicine Healthy Heart (PMHH) Study is a randomized clinical trial testing the effectiveness of a system designed to offload work from primary care clinicians and improve patient follow-through with risk reduction strategies by using a centralized team of nonclinical navigators and advanced practice providers, remote monitoring, and bi-directional text messaging, augmented by behavioral science engagement strategies. The intervention builds on prior nonrandomized evaluations of these design elements that demonstrated significant improvement in patients’ systolic blood pressure and LDL Cholesterol (LDL-C).
Primary Hypothesis
Penn Medicine Healthy Heart will significantly improve systolic blood pressure and LDL-C compared to usual care over the 6 months of this intervention.
Design
Randomized clinical trial of Penn Medicine Healthy Heart in patients aged 35-80 years at elevated risk of ASCVD whose systolic blood pressure and LDL-C are not well controlled. The intervention consists of 4 modules that address blood pressure management, lipid management, nutrition, and smoking cessation, offered in a phased approach to give the participant time to learn about each topic, adopt any recommendations, and build a relationship with the care team.
Sites
University of Pennsylvania Health System at primary care practices located in inner-city urban and rural/semi-rural areas.
Primary Outcomes
Improvement in systolic blood pressure and LDL-C.
Secondary Outcomes
Cost-effectiveness analyses are planned to evaluate the health care costs and health outcomes of the intervention approach. An implementation evaluation is planned to understand factors influencing success of the intervention.
Estimated Enrollment
2,420 active patients of Penn Medicine primary care practices who have clinical ASCVD, or who are at elevated risk for ASCVD, and who are (a) not on statins or have LDL-C >100 despite being on statins and (b) had systolic blood pressure >140 at 2 recent ambulatory visits.
Enrollment Dates
March 2024-March 2025. The intervention will last 6 months with a 12-month follow-up to determine whether its effects persist.
期刊介绍：
The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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