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Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology
Rongzi Shan1,2, Jie Ding1, Daniel Weng3
1Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA.
Insights
Digital health monitoring after acute myocardial infarction (AMI) is feasible. Many patients had uncontrolled blood pressure (BP), especially those with prior cardiovascular disease (CVD), indicating a need for improved secondary prevention.
Area of Science:
- Preventive Cardiology
- Digital Health
- Cardiovascular Disease Management
Background:
- Rising interest in digital health for blood pressure (BP) management in preventive cardiology.
- Acute myocardial infarction (AMI) necessitates effective post-discharge BP monitoring and management.
Purpose of the Study:
- To examine the feasibility of a digital health program for early BP assessment post-AMI.
- To determine the proportion of post-AMI patients with controlled BP and hypotension.
- To investigate the association between prior cardiovascular disease (CVD) and BP levels post-AMI.
Main Methods:
- Substudy of the MiCORE trial involving type 1 AMI patients (October 2017-April 2019).
- Participants used FDA-approved wireless BP monitors and a smartphone app for self-monitoring up to 30 days post-discharge.
- Linear mixed-effects models analyzed BP trajectory, adjusting for medications and CVD risk factors.
Main Results:
- 68 AMI patients provided 2638 BP measurements.
- BP control (<130/80 mmHg) was achieved in 59.6% of patients; <140/90 mmHg in 83.7%.
- Hypotension was rare (systolic <90 mmHg: 1.1%; diastolic <60 mmHg: 3.9%).
- Prior CVD was linked to higher mean daily systolic BP during admission (12.2 mmHg increase) and follow-up.
Conclusions:
- The digital health program for post-AMI BP monitoring is feasible.
- Approximately 40% of engaged patients had uncontrolled BP, particularly those with prior CVD, highlighting a gap in secondary prevention.
- Integration of digital health presents an opportunity for more aggressive early secondary prevention strategies post-MI.
Objective:
There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI.
Methods:
In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors.
Results:
Sixty-eight AMI patients (mean age 58 ± 10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3-64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3-87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17-2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6-5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5-20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP.
Conclusion:
The digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.
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