Imagine having a personal health companion by your side, guiding you towards a healthier heart every step of the way. Heart experts at Penn Medicine have created a tool that, they say, can fill that very role through text messaging.
Heart disease is the top cause of illness and death in the U.S. Penn Medicine Healthy Heart (PMHH) is a vital part of a comprehensive effort to combat heart disease, the ASCVD (atherosclerotic cardiovascular disease) Risk Reduction Initiative. This six-month text-messaging based program will soon be available to around 2,000 primary care patients in Philadelphia and Lancaster Counties, as part of a clinical trial.
The mission is to help patients to lower their risk of heart disease by managing their blood pressure and cholesterol levels from the comfort of their homes. Using tools like remote blood pressure monitoring, cholesterol counseling, medication management, personalized healthy eating resources, and smoking cessation support delivered via text, phone, and video, the goal is to make the expertise of Penn Medicine care staff more accessible.
PMHH was developed after two years of rigorous pilot testing in collaboration with specialists, primary care providers (PCPs), and patients across Penn Medicine. The program aims to provide easier access to patient care in between office visits to reduce patients' risk of heart disease. Marguerite Balasta, MD, medical director of PMHH, and Kevin Volpp, MD, PhD, the principal investigator of PMHH and director of the Penn Center for Health Incentives and Behavioral Economics, explained how the program works and who is eligible.
A program that uses tools to monitor patients outside of a clinical environment is often referred to as a ‘hovering’ program. What is the value in using a program like this?
PMHH extends care outside of traditional office-based visits to increase patient access in lowering their risk of heart attacks and strokes by improving their blood pressure and cholesterol. This means that patient needs can be more frequently addressed between office visits rather than wait weeks or months until the next appointment to make changes in blood pressure and cholesterol management. Combining hovering with a centralized team working in collaboration with PCPs helps to improve patients' cardiovascular health and create a supportive experience for patients.
Why now? What technologies made this program possible to launch in 2024?
Prior to the ready availability of electronic medical records and text-capable cell phones, interventions to reduce atherosclerotic cardiovascular disease (ASCVD) risk relied on patient office visits or hospital-based care. The greater availability of remote patient monitoring and telemedicine in the last few years has created opportunities for reaching outside the traditional models of health care delivery to bring more timely, convenient, and high-quality care to patients. This program leverages new technologies for proactive outreach and health management to a large population of patients.
How do you make sure patients are comfortable with participating in a program like this while also keeping the frequency of messages manageable?
Our program is careful to meet the patient where they are. We want to make things easier for them without providing more of a focus on their health than they are ready for. We use a lot of insights from behavioral economics to make the program more engaging and easily approachable for patients.
For example, while the texts are automated, they are tailored to individual patient needs and level of engagement. Patients will receive monthly reminders to check their blood pressure and automated medication adherence texts, but we also give patients a few extra days each month to catch up on missed BP checks if life was busy. There will be a one-time text about nutritional services and basic information about healthy eating.
Each patient will have the opportunity to build a relationship with a navigator accessible via two-way text messages and phone calls. All PMHH team members have received training about cardiovascular disease, motivational interviewing, and cultural awareness which is important knowledge that builds trust with patients. Patients can also unenroll or opt out of the program at any time.
How do you plan on measuring success for this program?
Our goal is to demonstrate the effectiveness of PMHH in benefiting our patients, providers, and health care system. Better clinical outcomes are lower blood pressures and lower cholesterol for patients who have finished the six-month program. We will also be interviewing patients and providers to learn from their experiences. One of the pilot programs that was created during the development stages of this project delivered in prescribing statins to patients that needed them.
What is next for PMHH?
The trial will run from February 2024 to approximately April 2025 as we enroll patients in four batches. Eligible patients will be identified by the PMHH team in collaboration with their primary care providers and contacted by text message. If you are currently receiving care at Penn Medicine, you may be contacted to participate if you meet eligibility criteria. Based on trial results, we are excited to pursue scale of the Healthy Heart program into normal clinical care and expand enrollment to more patients who could benefit at Penn Medicine and potentially across the region.
If people are interested in improving their heart health, where can they go?
Find a provider who can help you manage high blood pressure, high cholesterol, and other conditions that may be keeping you from living your healthiest life.