Design and rationale of the cardiometabolic health program linked with community health workers and mobile health telemonitoring to reduce health disparities (LINKED-HEARTS) program

• Published in: The American heart journal 2024-09, Vol.275, p.9-20
• Main Authors: Commodore-Mensah, Yvonne, Chen, Yuling, Ogungbe, Oluwabunmi, Liu, Xiaoyue, Metlock, Faith E., Carson, Kathryn A., Echouffo-Tcheugui, Justin B., Ibe, Chidinma, Crews, Deidra, Cooper, Lisa A., Himmelfarb, Cheryl Dennison
• Format: Article
• Language: English
• Subjects: Adult; Adults; Blood levels; Blood pressure; Blood Pressure Monitoring, Ambulatory - methods; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Chronic illnesses; Community health care; Community Health Workers; Cost effectiveness; Design; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; Disease control; Disease management; Female; Glucose; Health care access; Health disparities; Heart diseases; Humans; Hypertension; Hypertension - epidemiology; Hypertension - therapy; Intervention; Kidney diseases; Male; Medical personnel; Minority & ethnic groups; Patients; Population studies; Poverty; Primary care; Remote monitoring; Renal Insufficiency, Chronic - therapy; Risk factors; Smartphones; Stroke; Telemedicine; Text messaging; Web portals
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2024.05.008

Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The “LINKED-HEARTS Program” (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS”), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (