Leveraging Preexisting Cardiovascular Data to Improve the Detection and Treatment of Hypertension: The NOTIFY-LVH Randomized Clinical Trial.

Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.

定制的数据系统结合由受过培训的非医生人员增强的护理有潜力改善心血管护理。

Background

To determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention.

确定是否可以利用先前收集的心血管成像数据，通过系统级干预来改善高血压的检测和治疗。

DESIGN, SETTING, AND PARTICIPANTS: The NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area.

设计、环境和参与者：NOTIFY-LVH试验是一项两臂、实用的随机临床试验，于2023年3月至2024年6月在马萨诸塞州大波士顿地区的马萨诸塞州综合布里格姆卫生保健系统内进行，该系统是一个服务于大波士顿地区的多机构网络。

The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications.

该研究纳入了那些在之前的超声心动图中被诊断为左心室肥厚（LVH），没有已确立的心肌病诊断，并且没有接受抗高血压药物治疗的Mass General Brigham初级保健联盟的个体。

Patients were followed for 12 months postintervention.

患者在干预后被随访了12个月。

intervention

Population health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care.

人群健康协调员联系了被随机分配到干预组的患者的临床医生，通知他们左心室肥厚的情况，并提供随访护理的帮助。

A clinical support pathway-including 24-hour ambulatory blood pressure monitoring or cardiology referrals-was provided to aid LVH evaluation.

提供了一条临床支持路径——包括24小时动态血压监测或心脏病学转诊——以帮助评估左心室肥厚。

main_outcomes_and_measures

The primary outcome was the initiation of an antihypertensive medication.

主要结果是开始使用抗高血压药物。

Secondary outcomes included new hypertension and cardiomyopathy diagnoses.

次要结果包括新的高血压和心肌病诊断。

Results

A total of 648 patients were randomized-326 to the intervention and 322 to the control.

共有648名患者被随机分配-326名接受干预，322名作为对照。

Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female.

患者的平均年龄（标准差）为59.4（10.8）岁，女性患者248名（占38.3%）。

A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher.

在基线时，共有102名患者（15.7%）被诊断为高血压，109名患者（20.1%）的门诊平均血压为130/80毫米汞柱或更高。

Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; P < .001).

在12个月的随访期间，干预组有53名患者（16.3%）被开具了降压药物治疗，而对照组有16名患者（5.0%）（调整后的比值比[OR]为3.76；95%置信区间为2.09-6.75；P < .001）。

Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; P < .001).

干预组的个体也更可能被诊断为高血压（调整后的比值比，4.43；95% 置信区间，2.36-8.33；P < .001）。

Cardiomyopathy diagnoses did not significantly differ between groups.

两组之间的心肌病诊断没有显著差异。

conclusions_and_relevance

In the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator-led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension.

在NOTIFY-LVH随机临床试验中，通过集中式人群健康协调员领导的通知和临床支持途径，为先前超声心动图显示左心室肥厚的个体提供治疗，增加了高血压的初始治疗。

This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system.

本研究强调了利用现有但可能未充分利用的心血管数据的潜在益处，通过增强传统门诊护理系统的机制来改善医疗保健服务。

trial_registration

ClinicalTrials.gov Identifier: NCT05713916.

临床试验注册号：NCT05713916。