RESUMO
INTRODUCTION: Effective management of hypertension (HTN) is a priority in primary care. With telehealth now considered a staple care delivery method, uninsured and low-income patients without home blood pressure (BP) monitors may need additional attention and resources to achieve successful HTN control. METHODS: This prospective study at an underserved community clinic assessed the impact of distributing free BP monitors on patients' HTN control and therapy adherence. Enrollees were randomized into 2 groups, both completing 4 primary care physician (PCP) visits over a 6-month study period. Intervention participants collected home BP readings to report to their PCP and comparison participants completed an equivalent number of visits without having home BP data available for their PCP to review. Both groups completed an initial and final Therapy Adherence Scale (TAS) questionnaire. RESULTS: 263 patients were invited and 200 participants (mean age 50, 60% female, 19% Black, 67% Hispanic) completed the study. Intervention and comparison subjects featured comparable initial BP levels and TAS scores. After adjusting for age, race, ethnicity, sex, presence of diabetes and therapy adherence, intervention participants experienced higher odds of controlled HTN (OR 4.0; 95% Confidence Interval 2.1 to 7.7). A greater proportion of participants achieved BP control in the intervention arm compared with the comparison arm (82% vs 54% of participants, P < .001). TAS scores were higher in the intervention group (Mean = 44.1 vs 41.1; P < .001). DISCUSSION: The provision of free home BP monitors to low-income patients may feasibly and effectively improve BP control and therapy adherence.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Pobreza , Humanos , Feminino , Masculino , Hipertensão/diagnóstico , Hipertensão/terapia , Pessoa de Meia-Idade , Estudos Prospectivos , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Adulto , Atenção Primária à Saúde , Telemedicina/métodos , Telemedicina/instrumentação , Empoderamento , Cooperação do Paciente/estatística & dados numéricos , Idoso , Adesão à Medicação/estatística & dados numéricosRESUMO
Ventricular perforation during exposure of an intramyocardial left anterior descending artery (LAD) in preparation for coronary artery bypass grafting is a known surgical complication. In this report, we discuss the management of this complication which avoids closure of the LAD and a myocardial infarction.