Impact of providing at-home medical device kits on remote monitoring of individuals with cystic fibrosis

Background: Cystic fibrosis (CF) is a chronic, multi-system disease that can greatly affect quality of life, so it is important for people with CF to be closely evaluated. Routine care includes measurement of basic vital signs, which allows providers to assess respiratory, cardiovascular, and nutritional status, all of which are aspects people with CF at high risk of decompensation because of the disease's pathophysiology [1]. Providing patients with home devices can improve access to vital sign monitoring, which in turn can expand the scope of telehealth and bring attention to daily changes in a patient's overall health [2]. We predict that providing patients with medical devices to monitor vitals will benefit their overall health and wellbeing. Method(s): Medical device kits were offered to patients coming for their routine in-person visits at VCU Health Mayland Medical Center. Each kit contained a tape measure, pulse oximeter, thermometer, blood pressure apparatus, and weight scale. Before receiving the kit, patients who agreed to participate in the study filled out a pre-distribution survey that was modeled after the Centers for Disease Control and Prevention Health- Related Quality of Life-14. If patients did not know how to use a device, health care staff instructed them on its use. Twoweeks after they received the kit, patients were emailed a post-distribution survey that assessed the usefulness of each medical device. Result(s): Seventeen of 18 patients (94.4%) agreed to participate in the study. From the pre-distribution survey, 11.8% of patients frequently monitored their vitals;94.1% of those believed that using the devices would help improve the maintenance of their health, and 82.3% were aware of normal values for blood pressure, pulse, oxygen level, and body temperature and how to measure height and weight. All six of the 17 (35.3%) patients who responded to the post-distribution survey stated that the devices had worked as intended and that they did not find the devices too time consuming. Of the five devices that patients received, most patients found the pulse oximeter and blood pressure apparatus to be useful (100%), followed by the weight machine (75%), thermometer (50%), and tape measure (0%). Conclusion(s): Although most patients agreed that monitoring their vital signs at home would help maintain or enhance their health (94.1%), before this study, only two (11.8%) indicated that they regularly self-measured their vital signs. Overall, patients received being provided home devices was overall positively, with the pulse oximeter and blood pressure apparatus being the most popular. Reasons included ease of access and ability to self-triage and determine the urgency of seeing a health care provider if feeling unwell. The results of this study highlight not only patient desires to be more involved with their health, but also the importance of continuing to find ways to optimize remote monitoring during this COVID era.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Early Impact of Collaborative Remote Patient Monitoring (C-RPM) for Hypertension on Underserved Populations during the COVID19 Pandemic: A Multicenter Retrospective Observational Study

Introduction: Underserved populations are 40% more likely to have hypertension and three times more likely to die from heart diseases due to uncontrolled blood pressure (BP). Disrupted access to care from the COVID-19 pandemic further puts these populations at higher risks of complications. A C-RPM for hypertension was established in response to this threat. Research Question or Hypothesis: Will C-RPM promote timely BP control among underserved patients during the COVID19 pandemic? Study Design: A retrospective, single-arm observational study conducted in two federally qualified health center sites. Method(s): All adult patients with uncontrolled BP (>=140/90) who received physician or nurse practitioner referral to participate in CRPM were included. Patients who failed to use BP device independently were excluded. All participants received a BP device that transmitted their BP measurements to the institution electronic health records. Clinical pharmacists, under a collaborative practice agreement, followed the readings and provided dose adjustments via telemedicine. Patient demographics were collected at baseline and BP readings were tracked daily for the first three months. Descriptive analysis, ASCVD risk calculator and paired t-test were used accordingly. Result(s): Between August and December 2021, 89 patients were referred, of which 70 (78.7%) monitored BP daily while 19 (21.3%) were lost to follow up. The average age of the patients was 60.8 years with majority being Hispanic (76.4%), female (63%), and diagnosed with type 2 diabetes (52.8%). The average BP improved from 163/82 at baseline to 132/71 at three months (p<0.001) with an average ASCVD risk score reduction of 25%. Approximately 76% achieved BP target (<140/90) within three months. BP of those lost to follow up maintained uncontrolled over the three months. Conclusion(s): C-RPM achieved clinically meaningful and timely improvement in BP control and cardiovascular risks among underserved patients, bypassing the threat of care access disruption due to the COVID19 pandemic.

Sympathetic neural overdrive, endothelial dysfunction and aortic stiffness in coronavirus disease 2019 survivors: A short-term study of cardiovascular sequelae

Introduction: Coronavirus disease 2019 (COVID-19) has become one of the more dramatic health problems in the century. This disease has enormous consequence for the health care worldwide. In addition to high mortality rate, patients recovered from COVID-19 present short and long-term cardiovascular sequelae including chest pain, myocardial dysfunction, arrhythmia, dyspnea, breathlessness, postural tachycardia syndrome, and thrombotic complications. The explanations for these clinical manifestations are still uncertain but can involve a constellation of physiological alterations. Hypothesis: To test if COVID-19 survivors have augmented sympathetic outflow, diminished endothelial function, elevated aortic stiffness, and reduced physical capacity compared to healthy individuals. Methods: Nineteen COVID-19 survivors [age: 47.0±2.3 years, BMI: 30.1±1.2 Kg/m2] and eighteen well-matched healthy controls (age: 44.0±2.0 years, BMI: 28.4 ±1.2 Kg.m2] were included in study. COVID-19 survivors were evaluated within 6 months of original diagnosis by RT-PCR. Muscle sympathetic nerve activity (MSNA) from fibular nerve (Microneurography), brachial artery flowmediated dilation (BAFMD;Doppler-Ultrasound), carotid-femoral pulse wave velocity (cf-PWV;Complior), beat-to-beat blood pressure (Peripheral BP;Finometer), heart rate (HR;Electrocardiography) and peak oxygen uptake (VO2peak, Cardiopulmonary exercise testing) were measured in both groups. Results: MSNA was higher in COVID-19 survivors compared to controls (33.0±1.0 vs. 22.0±1.0 bursts/min, p=0.001). Both BAFMD and VO2peakwere lower in COVID-19 survivors compared to controls (4.6±0.7 vs. 8.2 ±0.8%, p=0.005 and 22.2±1.5 vs. 29.7±1.6 mL/Kg/min p=0.001, respectively). Although COVID-19 survivors had greater cf-PWV than controls (8.6±0.5 m/s vs. 7.4±0.4 m/s, p=0.03), BP and HR were not different between groups. Conclusions: Our study revealed that patients recently recovered from COVID-19 have abnormal neurovascular control, vascular alterations and reduced physical capacity. These findings strongly indicate the need of further long-term investigations to uncover cardiovascular sequelae provoked by COVID-19.