Low-income patients with treatable cardiac risk factors may benefit from telemedicine

Low-income patients with treatable cardiac risk factors may benefit from regular visits with an Internet based telemedicine doctor, according to interim results of a $4 million dollar study funded by the Pennsylvania State Department of Health and headed by Alfred Bove, MD, chief of cardiology at Temple University School of Medicine and Hospital.

Designed to help bridge what Bove terms the "medical divide" between treatment and outcomes for upper- and lower income patients, the study results show that inner city and rural patients who used the telemedicine system significantly reduced their cardiovascular disease (CVD) risk factors over a period of eight months.

Participants, all of whom had a risk for heart disease based on the Framingham Study, were randomly divided into a control or telemedicine group and received a pedometer to measure their daily steps, along with advice on exercising and its benefits in preventing heart disease. The telemedicine group, however, also regularly transmitted their blood pressure, weight and step data to cardiologists, and, in return, received feedback and educational information via the Internet.

After eight months, the telemedicine participants showed 'significant reductions' in systolic and diastolic blood pressure, body mass index and overall risk of heart disease, while the control group achieved only a meaningful drop in systolic blood pressure.

In addition, those involved in the telemedicine group also pumped up their exercise, leading investigators to conclude that as patients took greater responsibility for their health and became better informed about CVD, their efforts and the levels of exercise performance increased.

Like most of the general population, researchers found that all of the study participants tended to be 'overly optimistic' when estimating their personal CVD risk. Women in the group had a lower actual CVD risk than male counterparts, but their perceived risk of heart disease was significantly higher than the men. Women were also more knowledgeable about the disease. Men who lived in the inner city tended to have the lowest perception of risk and the least knowledge about cardiovascular disease, despite the magnitude of their actual risk.

Bove hopes that by using innovative strategies like self-monitoring and self-reporting, traditionally underserved patients will eventually insist on better health care and that this enhanced patient literacy might begin to bridge what he calls the "medical divide" - the divergent health status and medical outcomes for higher- versus lower- income patients.

"The most important thing to improve patient compliance is to have the patient address their physician with a request for care and express knowledge of their condition," he says. "Only when everyone reaches a new level of health education can everyone be a truly equal citizen."