When healthy patients are at high risk for cardiometabolic disease -- a life-threatening combination of stroke, diabetes and heart disease -- what they do between doctor's visits is essential to lowering that risk as much as possible. But it can be hard to make lifestyle changes. Now, one clinic has shown that remote visits with care providers can make a measurable difference.
Cardiologist Rajesh Dash, MD, PhD, directs the Stanford South Asian Translational Heart Initiative (SSATHI), a clinic that focuses on preventing cardiometabolic disease in South Asian individuals, whose risk for this disease is four times higher than other ethnicities. To help his patients adhere to a potentially lifesaving prevention regimen, Dash and his colleagues came up with a telehealth approach -- technology that connects patients to their care team remotely -- that would support his patients' efforts to stay on track with their risk-reduction program and get healthier. The results, Dash said, were remarkable.
But understanding how to achieve those benefits required some disruptive thinking. When the SSATHI clinic opened in 2014, Dash had started many of his patients on an intense, six-month preventive treatment program that included three physician visits, and two to three dietitian visits.
"We found that patients would generally not make the second physician visit and only make it to the third," Dash said. "And the majority of our patients were only seeing the dietitian once." The team discovered that many of the SSATHI patients were struggling to stay on track with that program. "After asking our patients why it wasn't working for them, we found it was primarily due to our not engaging with patients between our in-person visits," Dash said.
Dash describes the discovery as "humbling," adding that he now believes that successful prevention and treatment of chronic cardiometabolic diseases "hinges upon frequent patient engagement from the care team." Making that happen required some creativity and letting go of the idea that all visits had to happen in person.
Last year, he and his team launched a program they coined CardioClick, which includes one in-person physician visit and two virtual visits over six months, which are conducted via the Stanford MyHealth app. Patients also have six to 12 virtual "lifestyle" sessions, based on an intervention program developed by SSATHI's dietitian, Vijaya Parameswaran, who is also the CardioClick program coordinator. In each session, a member of the care team checks in on the patient's progress with diet, exercise, sleep and other health factors.
"With this CardioClick structure, the majority of our patients are seeing their physician three times, as scheduled, and doing lifestyle visits as we had designed, all within the six-month time frame," Dash said. This was a big change over the prior in-person clinic program, in which patients took a year or more on average to complete their visits -- if they completed them at all, he added.
In the past six months more than 50 patients have completed the six-month program, Dash said. He and his team compared the before and after lab results and cardiovascular risk biomarkers and found that the CardioClick patients were more responsive to the program. Better still, their health was improving. "We are also observing that every important risk factor for heart disease -- LDL cholesterol, triglycerides, blood pressure, body mass index, insulin resistance and more -- is improving more frequently and to a greater magnitude in the CardioClick population," Dash said. The results -- which will be presented in an abstract at this year's American Heart Association EpiLifestyle Conference -- surprised even him.
"We were actually astonished by the dramatic shift in our clinic results, as many of these patients were considered unsuited to our preventive program," Dash said. "We are thrilled and so are our patients."
The team's success with CardioClick has encouraged them to consider other types of technology -- medical device and software -- that could help patients succeed in their prevention programs.
"One of our active clinical trials is testing the impact of a home scale that is cellular connected," Dash said. The device, made by BodyPort Inc, goes beyond tracking body weight to measure body composition as well as the electrical and mechanical function of the heart. The device communicates the data back to the patient's care team at Stanford.
"This type of passive home sensor data provides a critical window into interval patient progress -- or lack thereof -- and can help us be more efficient, targeted, and timely with our feedback to patients," Dash said. "We are now deciding amongst several additional diagnostic and treatment protocols that all leverage technology company collaborations to push toward excellence in remote patient care."
Photo by Jira