Patterns of Adherence to Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: An Analysis From the RESILIENT Trial of Mobile Health Cardiac Rehabilitation.

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiopulmonary Rehabilitation and Prevention Pub Date : 2025-01-01 Epub Date: 2024-11-28 DOI:10.1097/HCR.0000000000000911

Lara C Kovell, Victoria Bothwick, Paul McCabe, Stephen P Juraschek, Yuchen Meng, Ritika Revoori, Stephanie Pena, Antoinette Schoenthaler, Samrachana Adhikari, John A Dodson

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引用次数: 0

Abstract

Purpose: Hypertension (HTN) is common and represents a major modifiable risk factor for ischemic heart disease in older adults. While home blood pressure monitoring (HBPM) is important in HTN management, patterns of HBPM engagement in older adults undergoing mobile health cardiac rehabilitation (mHealth-CR) are unknown. We aimed to identify patterns of adherence to HBPM in a cohort of older adults undergoing mHealth-CR to optimize HBPM use in the future.

Methods: We used interim data from the ongoing Rehabilitation using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting (RESILIENT) randomized trial, in which intervention arm participants (adults ≥ 65 years with ischemic heart disease) were instructed to monitor blood pressure (BP) at least weekly. Engagement groups were determined by latent class analysis and compared using ANOVA or Chi-Square tests. Longitudinal mixed effect modeling determined the associations between weekly HBPM and baseline covariates including uncontrolled HTN, obesity, diabetes, depression, alcohol, and tobacco use.

Results: Of the 111 participants, the mean age was 71.9 ± 5.6 years, and 83% had HTN. Over the 12-week study, mean HBPM engagement was 2.3 ± 2.3 d/wk. We observed 3 distinct patterns of engagement: high engagement (22%), gradual decline (10%), and sustained baseline engagement (68%). HBPM adherence decreased in two of the engagement groups over time. Of the covariates tested, only depression was associated with weekly HBPM after adjusting for relevant covariates (OR 9.09, P = .03).

Conclusions: In this older adult cohort undergoing mHealth-CR, we found three main engagement groups with declining engagement over time in two of the three groups. These patterns can inform future mHealth-CR interventions.

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患有缺血性心脏病的老年人坚持进行家庭血压监测的模式：移动医疗心脏康复 "RESILIENT "试验分析。

目的：高血压（HTN）很常见，是老年人缺血性心脏病的主要可改变风险因素。虽然家庭血压监测（HBPM）在高血压管理中非常重要，但接受移动健康心脏康复（mHealth-CR）的老年人参与 HBPM 的模式尚不清楚。我们旨在确定接受移动医疗心脏康复的老年人群体中坚持 HBPM 的模式，以便在未来优化 HBPM 的使用：我们使用了正在进行的 "利用移动医疗为家中患有缺血性心脏病的老年人提供康复服务"（RESILIENT）随机试验的中期数据，在该试验中，干预组参与者（年龄≥ 65 岁、患有缺血性心脏病的成年人）被要求至少每周监测一次血压。通过潜类分析确定参与组别，并使用方差分析或齐方差检验进行比较。纵向混合效应模型确定了每周 HBPM 与基线协变量（包括未控制的高血压、肥胖、糖尿病、抑郁、酗酒和吸烟）之间的关系：在 111 名参与者中，平均年龄为 71.9 ± 5.6 岁，83% 患有高血压。在为期 12 周的研究中，参与 HBPM 的平均时间为 2.3 ± 2.3 天/周。我们观察到三种不同的参与模式：高度参与（22%）、逐渐下降（10%）和持续基线参与（68%）。随着时间的推移，其中两个参与组的 HBPM 坚持率有所下降。在测试的协变量中，经调整相关协变量后，只有抑郁与每周 HBPM 相关（OR 9.09，P = .03）：在这个接受移动保健-CR 的老年人群中，我们发现有三个主要的参与群体，其中两个群体的参与度随着时间的推移在下降。这些模式可以为未来的移动医疗-CR 干预提供参考。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiopulmonary Rehabilitation and Prevention 医学-心血管系统

CiteScore

5.40

自引率

34.20%

发文量

164

审稿时长

6-12 weeks

期刊介绍： JCRP was the first, and remains the only, professional journal dedicated to improving multidisciplinary clinical practice and expanding research evidence specific to both cardiovascular and pulmonary rehabilitation. This includes exercise testing and prescription, behavioral medicine, and cardiopulmonary risk factor management. In 2007, JCRP expanded its scope to include primary prevention of cardiovascular and pulmonary diseases. JCRP publishes scientific and clinical peer-reviewed Original Investigations, Reviews, and Brief or Case Reports focused on the causes, prevention, and treatment of individuals with cardiovascular or pulmonary diseases in both a print and online-only format. Editorial features include Editorials, Invited Commentaries, Literature Updates, and Clinically-relevant Topical Updates. JCRP is the official Journal of the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.