Table 1
Baseline data and demographics of the included patients.
| INCLUSION CRITERIA | EXCLUSION CRITERIA |
|---|---|
| Age ≥ 18 years | Persistent atrial fibrillation as indicated in the health record |
| Newly diagnosed or confirmed hypertension patients with BP > 140/90 mmHg | Pregnant or planning to become pregnant during the study period |
| Have or have access to a smartphone with internet access throughout the study period | Severe kidney disease, defined as estimated glomerular filtration rate < 30 per 1.73 m2 or currently on renal replacement therapy (i.e., hemodialysis or peritoneal dialysis) |
| Able to provide written informed consent prior to participation in the study | Recent cardiovascular event (ischemic stroke, transient ischemic attack, myocardial infarction, coronary artery bypass grafting) in the past three months |
| Diagnosis of dementia, psychosis, as indicated in the health record | |
| Life expectancy < 1 year; for instance, in terminal cancer or NYHA III or IV heart failure | |
| Individuals requiring BP monitor cuff size larger than 42 cm |
Figure 1
Telemonitoring organization and alert processing. Patients measure their BP at home using a validated BP machine. These measurements can trigger simple, complex, or inactive/overdue alerts. These alerts are either processed automatically by the telemonitoring platform or manually by a healthcare provider in the hospital. Feedback to the patients is provided automatically by the telemonitoring platform (e.g., a protocol switch) or manually by the E-nurse (e.g., a treatment adjustment).
Figure 2
Study flowchart.
Table 2
Baseline data and demographics of the included patients.
| Total number of study participants | 84 |
| Age, mean (SD) | 54 (14) |
| Female, n (%) | 61 (73%) |
| Hypertension, n (%) | 84 (100%) |
| Diabetes, n (%) | 5 (6%) |
| Smoking, n (%) | 2 (2%) |
Table 3
Blood pressure data, antihypertensive drug use, and consultations.
| % of patients with BP < 140/90 mmHg at baseline | 0% | |
| % of patients with BP < 140/90 mmHg at six months | 72% | P < 0.0001* |
| Baseline systolic BP mmHg (mean, SD) | 157 (18) | |
| T = 6 months systolic BP mmHg (mean, SD) | 128 (12) | P < 0.0001** |
| Baseline diastolic BP mmHg (mean, SD) | 97 (8) | |
| T = 6 months diastolic BP mmHg (mean, SD) | 82 (12) | P < 0.0001** |
| Number of antihypertensives baseline (median, IQR) | 2 (2–3) | |
| Number of antihypertensives six months (median, IQR) | 3 (2–3) | |
| Number of physical consultations during study period (median, IQR), not including baseline and T = 6-month study visit | 1 (0–2) |
[i] * = McNemar test for proportions; ** = paired T-test.
Table 4
Telemonitoring data.
| Telemonitoring participation | |
| Total average days active in the HBPT program in days (months) | 276 (9.2) |
| Total individual measurements (heart rate, systolic BP, diastolic BP) | 28785 |
| Total combined measurements (heart rate, systolic BP, diastolic BP combined in one single measurement) | 9595 |
| Total combined measurements per participating patient | 114 |
| Average measurement schedule adherence* | 22% |
| Telemonitoring alerts | |
| Total alerts | 1677 |
| Simple alerts | 930 (55%) |
| Complex alerts | 747 (45%) |
| Total alerts per patient | 20 |
| Telemonitoring alert processing | |
| Alerts auto processed by telemonitoring platform (% total alerts) | 579 (35%) |
| Manual alerts processed (% total alerts) | 1098 (65%) |
| Administrative action (% total manually processed alerts) | 612 (56%) |
| Contacted via phone (% total manually processed alerts) | 339 (31%) |
| Contacted via message (% total manually processed alerts) | 9 (1%) |
| Clinical action (% total manually processed alerts) | 138 (12%) |
| Telemonitoring time investment | |
| Phone (5 min), minutes, average per patient | 20.2 |
| Message (5 min), minutes, average per patient | 0.5 |
| Clinical action (10 min), minutes, average per patient | 16.4 |
| Administrative action (2 min), minutes, average per patient | 14.6 |
| Total average time investment (minutes) per patient during 9.2 months of telemonitoring | 51.7 |
[i] *515 measurements were expected based on an average bi-weekly measurement week with 28 combined measurements for a period of 9.2 months. Adherence was calculated by dividing the average combined number of measurements by the expected number of measurements (114/515).