Sphygmomanometer Research Articles

Medical device-related pressure injuries in paediatric patients: An incidence study in a children's hospital.

To determine the incidence of pressure injuries from medical devices in children. Medical devices can cause pressure injuries on skin and soft tissues. A prospective, descriptive study adhering to STROBE guidelines. This study was conducted in the third-level Paediatric Intensive Care Unit of Ege University Hospital in İzmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form. In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%). The incidence of medical device-related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices. The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness-raising and educational activities among health professionals and nurses should be accelerated. No patient or public contribution in the study.

Smartphone-Based versus Non-Invasive Automatic Oscillometric Brachial Cuff Blood Pressure Measurements: A Prospective Method Comparison Volunteer Study.

Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland-Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was -1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and -0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future.

Physical Noninvasive Attacks on Photoplethysmogram by Computer Controlled Blood Pressure Cuff.

Sensor data has been used in social security and welfare infrastructures such as insurance and medical care to provide personalized products and services; there is a risk that attackers can alter sensor data to obtain unfair benefits. We consider that one of the attack methods to modify sensor data is to attack the wearer's body to modify biometric information. In this study, we propose a noninvasive attack method to modify the sensor value of a photoplethysmogram. The proposed method can disappear pulse wave peaks by pressurizing the upper arm with air pressure to control blood volume. Seven subjects experiencing a rest environment and five subjects experiencing an after-exercise environment wore five different models of smartwatches, and three pressure patterns were performed. It was confirmed in both situations that the displayed heart rate decreased from the true heart rate.

Novel Peripheral Perfusion Dynamics Indices for Detecting and Grading Arterial Stenosis.

Peripheral artery disease causes severe morbidity, especially in diabetics and the elderly. There is a need for accurate noninvasive detection of peripheral arterial stenosis. The study has tested the hypothesis that arterial stenosis and the associated adaptation of the downstream circulation yield characteristic changes in the leg perfusion dynamics that enable early diagnosis, utilizing impedance plethysmography. The arterial perfusion dynamic was derived from impedance plethysmography (IPG). Two degrees of arterial stenosis were emulated by inflating a blood-pressure cuff around the thigh to 45 and 90mmHg, in healthy volunteers (n = 30). IPG signals were acquired continuously throughout the experiment. Ankle and brachial blood pressures were measured at the beginning of each experiment and at the end of each emulated stenosis phase. Thigh compressions did not affect the pulse-transit time, but prolonged the time to the peak perfusion wave. Segmentation of the perfusion upstroke into two phases, at the time point of maximum acceleration (MAT), revealed that arterial compression prolonged only the initial slow phase duration (SPd). The MAT and SPd were proportional to the emulated stenosis severity and detected the arterial stenosis with high sensitivity (>93%) and specificity (100%). The SPd increased from 46.4 ± 21.2ms at baseline to 75.4 ± 38.5ms and 145 ± 39ms under 45mmHg and 90mmHg compressions (p < 0.001), without affecting the pulse-transit time. The novel method and indices can identify and grade the emulated arterial stenosis with high accuracy and may assist in differentiating between focal arterial stenosis and widespread arterial hardening.

Blood pressure cuff–induced radial nerve palsy following minimally invasive lateral microdiscectomy: illustrative case

BACKGROUND The authors describe a rare case of transient postoperative wrist and finger drop following a prone position minimally invasive surgery (MIS) lateral microdiscectomy. OBSERVATIONS Hand and wrist drop is an unusual complication following spine surgery, especially in prone positioning. The authors’ multidisciplinary team assessed a patient with this complication following MIS lateral microdiscectomy. The broad differential diagnosis included radial nerve palsy, C7 radiculopathy, stroke, and spinal cord injury. Given the patient’s supinator weakness, intact pronation and wrist flexion, and transient recovery within 4 weeks, the most likely diagnosis was radial nerve neuropraxia secondary to ischemic compression. After careful consideration of the operative environment and anatomical constraints, the patient’s blood pressure cuff was found to be the most probable source of compression. LESSONS Blood pressure cuff–induced peripheral nerve injury may be a source of postoperative radial nerve neuropraxia in patients undergoing spine surgery. Careful considerations must be given to the blood pressure cuff location, which should not be placed at the distal end of the humerus due to higher susceptibility of peripheral nerve compression. Spine surgeons should be aware of and appropriately localize postoperative deficits along the neuroaxis, including central versus proximal or distal peripheral injuries, in order to guide appropriate postoperative management.

Electrical auricular tragus stimulation induces release of circulating cardioprotective factors in healthy human volunteers

Abstract Background Vagal activation during remote ischemic conditioning (RIC) with subsequent release of cardioprotective factors from the spleen into the circulation reduces infarct size. These humoral cardioprotective factors can be transferred with plasma-dialysate from human donors undergoing RIC to isolated recipient hearts where they reduce infarct size. Electrical auricular tragus stimulation (ATS) has been demonstrated to reduce the release of cardiac injury biomarkers and ventricular arrhythmias and to improve contractile function in patients with acute myocardial infarction. Purpose To determine whether ATS, as RIC, induces release of cardioprotective factors into the circulation. Methods Healthy volunteers (3 females, 7 males, 26±5 years) were randomized to receive ATS or RIC, respectively, with an interval of at least two weeks between protocols. ATS was induced by bipolar electrical rectangular pulses of 200 µs width and a frequency of 30 Hz. The amplitude (5.5 ± 0.81 mA) was set for each volunteer to not be perceived as uncomfortable. A microprocessor-controlled circuit periodically interrupted the stimulation signal after 5 s of stimulation for 5 s. ATS was continued over 30 min. RIC served as a reference to induce the release of cardioprotective factors by 3 x 5 min blood pressure cuff inflation at 200 mmHg on the left upper arm/ 5 min deflation. Venous blood samples were taken before and 60 min after ATS or RIC, respectively, and used to prepare plasma-dialysates (1:10 dialysis against buffer for 24 h, cut-off 12-14 kDa). Male Lewis rats were sacrificed and their hearts isolated and perfused at constant pressure with buffer. Plasma-dialysates from samples taken before and 60 min after ATS or RIC, respectively, were infused for 8 min into rat hearts followed by 2 min washout before global 30 min ischemia/ 120 min reperfusion. Infarct size was demarcated by triphenyl tetrazolium chloride staining and calculated as percent of ventricular mass. Results With infusion of plasma-dialysate before ATS, infarct size was 30.9 ± 4.5% of ventricular mass and not different from that with infusion of plasma-dialysate before RIC (35.8 ± 5.8 %). Infusion of plasma-dialysate after ATS reduced infarct size to 18.3 ± 3.9 %. This cardioprotective effect was similar to that seen with infusion of plasma-dialysate after RIC (20.1 ± 3.5 %). Conclusion ATS induces the release of cardioprotective factors into the circulation of healthy volunteers. Plasma-dialysates after ATS or RIC, respectively, reduce myocardial infarct size by the same magnitude in ex vivo isolated perfused rat hearts with global ischemia/ reperfusion.

Validation of a novel cuffless photoplethysmography-based wristband for measuring blood pressure according to the regulatory standard

Abstract Background Blood pressure is a key paramater in acute and chronic cardiovascular diseases (CVD) [1]. However, obtaining reliable and reproducible cuff blood pressure (BP) measurements is challenging. We demonstrate that a wristband-based PPG measurement in combination with a custom developed BP algorithm represents a possible alternative to cuff BP measurements. Purpose This study aimed to validate a novel cuffless photopletysmography (PPG)-based non-invasive wristband for continuous BP monitoring in accordance with ISO 81060-2:2019. Methods The study compared PPG-guided BP algorithm predictions with subclavian arterial reference measurements taken during cardiac catheterization. Eligible patients were consecutively included, and eligibility was screened following ISO 81060-2:2019 requirements. Reference measurements were performed using a validated invasive BP monitoring device with a sampling rate of 100Hz. PPG signals were collected using six light emission diodes and two photodiodes at a sampling rate of 128Hz. Three sequential initialization measurements were taken using a validated blood pressure cuff before the cardiac catheterization exam. These measurements, along with approximately 100 additional features (PPG-derived and based on patient demographics), were used as input for the machine learning-based BP algorithm. Correlation, mean error, and standard deviation (SD) were determined for systolic and diastolic BP measurements between the BP algorithm predictions and invasive reference measurements Results The study included 97 patients from whom 420 individual 30-second samples were obtained. The mean age, weight, and height of the analysed subjects were 67.1 (SD 11.1), 83.4 (SD 16.1), and 174.1 (SD 10.0), respectively. In 48 samples (11%), systolic BP was ≤100mmHg, while in 106 samples (25%), systolic BP was ≥160mmHg. Diastolic BP was ≤70 mmHg in 222 samples (53%) and ≥85 mmHg in 99 samples (24%). The BP algorithm predictions showed a high correlation with invasive reference measurements for systolic (r = 0.985) and diastolic (r = 0.961) BP measurements. The mean error of the BP algorithm predictions compared to the invasive reference measurements was ±3.7 mmHg (SD 4.4 mmHg) and ±2.5 mmHg (SD 3.7 mmHg) for systolic and diastolic BP, respectively. Results were similar within each gender and skin colour category (Fitzpatrick I-VI). Conclusion This study demonstrates that a wristband-based PPG measurement in combination with the developed BP algorithm can provide accurate continuous BP measurements across a wide range of BP distributions. Therefore, wristband BP monitoring may serve as a valid and less burdensome alternative to cuff BP measurements for both in-hospital and at-home BP monitoring. However, further research is necessary to evaluate the precision of the BP algorithm during movement and the stability of the predictions over time.figure of BP

Adjunct remote ischemic conditioning to PCI in ST-segment elevation myocardial infraction patients: Systematic review and meta-analysis

Abstract Introduction ST-segment elevation myocardial infarction (STEMI) is the most dangerous presentation of the acute coronary syndrome (ACS). Throughout the last three decades, clinicians have been attempting to reduce the short and long-term major adverse cardiac events (MACE) associated with STEMI. Remote ischemic conditioning (RIC) is one of the new adjunctive modalities to PCI in treating STEMI patients whereby brief reversible episodes of ischemia and reperfusion are applied to the tissue (by alternative cycles of inflation and deflation of a blood pressure cuff on the upper or lower limb) confers global protection and renders remote tissues resistant to ischemia/reperfusion injury. This review aims to provide reliable evidence from published randomized controlled trials (RCTs) regarding whether RIC is beneficial for STEMI patients or not. Methods We followed the PRISMA guidelines during the preparation of this systematic review and meta-analysis. A computer literature search for (PubMed, Web of Science, Scopes, and Google Scholar) was carried out. We included RCT, comparing the remote ischemic conditioning, regardless of its timing of application to PCI, with either placebo or sham procedure, in terms of both short-term and long-term cardio protection. Outcomes of myocardial salvage index, myocardial infarction size, and left ventricular ejection fraction were pooled as the standardized mean difference between the two groups from baseline to endpoint. Results 11 RCTs (7151 patients), were included in this analysis. The overall effect on short-term outcomes, was in favor of PCI only in terms of myocardial salvage index(P value=0.04, 95% CI [0.00-0.08]), and left ventricular ejection fraction(P value=0.05, 95% CI [0.02,2.16]), while the adjunctive application of remote ischemic conditioning was beneficial in terms of: myocardial infarct size ( P value=0.004, 95% CI [-3.22,-0.62]). Regarding the long-term outcomes, the overall effect did not show any benefit in either of the two groups in terms of: major adverse cardiac and cerebrovascular events (MACCE) (P value=0.13, 95% CI [0.48,1.10]), hospitalization for heart failure (P value=1.00, 95% CI [0.83,1.20]), and cardiac death (P value=0.91, 95% CI [0.73,1.32]). Conclusion The adjunctive application of RIC to PCI during treatment of STEMI patients showed a beneficial effect only on short-term reduction of myocardial infarct size, nevertheless, it was not of benefit regarding the other short and long-term metrics of myocardial salvage and left ventricular function.

Abstract 15804: Intervention to Improve Self-management of Blood Pressure for Low-Income Black Patients With Severe Hypertension

Background Hypertension is a leading cause of preventable mortality and morbidity and is disproportionately represented among minority populations. Despite proven interventions outlined in practice guidelines, only 48% of patients who are diagnosed with hypertension have their condition controlled. In a southeastern US county, the prevalence of hypertension is 42%, with a strong association with race, suggesting opportunities to intervene at a neighborhood level to reduce hypertension disparities and improve overall population health. Aims To improve access to care through targeted opportunities for self-management of blood pressure (BP). Methods: This quality initiative used a pre-post evaluation design. We identified Black low-income patients with uncontrolled hypertension (SBP &gt; 160 mmHg and/or DBP &gt; 100 mmHg) from a local federally qualified health center (FQHC). Trained student ambassadors provided telephone outreach, BP cuffs, and goal setting on AHA Essential 8 for 4 months. Follow-up occurred at 7 months. Results: Among Black participants (n=345), average age was 55.4 years (SD 8.7), and a majority were male (n=173, 50.1%) and uninsured (n=159, 46.1%). Engagement in calls occurred for 67.8% (n=234) of the cohort; cuff distribution was 22.9% (n=79); and AHA Essential 8 goal setting occurred for 64 patients. BP improved for 40% of the cohort (mean pre: 168/98 mmHg, mean post: 150/89 mmHg; p &lt;0.0001). Of the cohort reached, 33% expressed social needs such as food insecurity, housing, and medication costs. Conclusion Findings suggest that telephone outreach with student ambassadors successfully improves patient engagement and reduces blood pressure, on average.

Abstract 16544: A Multicenter Validation of a Noninvasive Brachial Cuff-ECG System for Estimation of Elevated Left Ventricular End Diastolic Pressure

Introduction: Measurement of left ventricular end diastolic pressure (LVEDP) is an established diagnostic method to evaluate all types of heart failure (HF). Invasive measurement of LVEDP requires an in-hospital procedure which limits accessibility. A noninvasive technique for detecting elevated LVEDP would significantly improve the diagnosis of HF, particularly in the outpatient setting. Herein we present the results of a multicenter study to validate a noninvasive system to detect elevated LVEDP. Methods: The Vivio System includes a modified blood pressure cuff and single lead ECG to capture brachial artery waveforms to assess preload, afterload and contractility. A model was created to identify patients with elevated LVEDP (&gt; 18mmHg). 728 patients were enrolled from 7 medical centers in the USA. All patients were referred for coronary angiography and left heart catheterization for clinical indications. A group of 321 patients with no known significant health problems were enrolled as a control group. Invasive LVEDP measurements were conducted using Millar catheters. The control group was assumed to have a LVEDP = 10 mmHg. The training dataset (n = 262, mean age 45 ± 19 yrs; 54% male) contained 101 patients with LVEDP measurements (n = 44 with LVEDP &gt; 18 mmHg) and 161 controls. The validation dataset (n = 155, mean age 46 ± 21 yrs; 62% male) contained 75 patients with LVEDP measurements (n = 40 with LVEDP &gt; 18 mmHg) and 80 controls. Results: Leave-one-out cross-validation on the training dataset yielded a sensitivity of 0.84 (95% confidence interval (CI): 0.70 - 0.93) and a specificity of 0.84 (95% CI: 0.79 - 0.89). The validation dataset showed a sensitivity of 0.80 (95% CI: 0.64 - 0.91) and a specificity of 0.83 (95% CI: 0.75 - 0.90). Figure 1 shows the overall classification performance. Conclusion: The Vivio System can accurately detect elevated LVEDP and has the potential to significantly improve early detection of HF in the outpatient setting.

Abstract 18935: A Prospective Evaluation of a Community-Based Outreach Initiative for Black Women With Severe, Uncontrolled Hypertension

Introduction: Despite American Heart Association evidence-based guidelines for care, inequities in prevalence and management of HTN disproportionately impact minority populations. Though studies have evaluated strategies to improve management of HTN and self-measurement of blood pressure (SMBP), existing strategies have not included a patient-partner who is a peer in literacy level, socio-economic status, and the lived experience of hypertension. Hypothesis: This pilot study was designed to evaluate a community-based intervention using patient-selected partners to improve blood pressure at 12 months. Secondary aims were to improve engagement in care, BP cuff distribution and use, and patient-centered goal setting for Life’s Essential Eight. Methods: We used a prospective, pre-post cohort design to evaluate the peer-partnership intervention. The team-based intervention included:1)Distribution of blood pressure cuffs and provision of skill-based training for BP self-monitoring to women at a federally qualified health center (FQHC).2) Implementation of coaching and feedback with patients on SMART goal setting for Life’s Essential Eight, to improve goal concordance and goal achievement. Results: Participants included Black women (n=335), average age 56 (SD 9.6). Preliminary results on key process measures indicate early signs of adoption: patient engagement in calls completed (n=426), cuffs distributed (n=186), SMART goals set (187, 56%), and partnerships established with family or community sites (n=91, 27%). Blood pressure was significantly reduced overall from baseline to 12 months (pre-systolic mean 172.05 (SD 13.3) mmHg versus post-systolic mean 140.3 (SD 20.9) mmHg; p&lt;.0001) Focus groups evaluating patient perceptions of the added value of peer-partnership are ongoing. Conclusions: Community-based partnerships may improve SMBP skills, goal setting, and communication among patients in minority and low socioeconomic groups.

Abstract 15517: Physician-Patient Engagement to Improve Ambulatory Systolic Blood Pressure

Introduction: Hypertension is a leading cause of death and disability-adjusted life-years globally. Using implementation science of the 2017 ACC/AHA Guideline for High Blood Pressure (BP) in Adults, we posited a quality improvement (QI) project targeting physician education and multidisciplinary patient engagement in two large urban ambulatory clinics to improve patient blood pressures. Hypothesis: We hypothesize that direct physician and patient education and engagement improves achievement of hypertension goals within ambulatory clinics. Methods: A QI initiative consisting of a half-day of resident hypertension education, patient access to home BP monitors, and direct patient engagement via physician outreach was conducted. Patients not at BP goal defined as systolic blood pressure (SBP) &gt;130 mmHg were followed over 8 months via multidisciplinary approach to ensure adequate follow-up appointments. Data was collected after 8-months and compared descriptively. BP ranges at month 0: Group A &lt;130 mmHg, Group B 130-139 mmHg, Group C 140-159 mmHg, Group D &gt;=160 mmHg. Emphasis was placed on Groups C and D. Results: A total of 6,030 patients had follow-up visits in the 8-month study window. At month 0, 874 patients fell within Group C and 301 within Group D. Of those in Group C, 29.5% achieved SBP goal (&lt;130 mmHg), 27.5% improved BP to 130-139 mmHg, and 34.4% remained within 140-159 mmHg at month 8. In Group D, 20.9% achieved goal SBP &lt;130 mmHg, 17.6% reached 130-139 mmHg, and 34.6% improved to 140-159 mmHg. (Figure 1). Limitations included patients without access to BP cuff during telehealth visits. Conclusions: Direct physician engagement and multidisciplinary approach to hypertension management led to decreased SBP readings. Further investigation is warranted to determine how these interventions affect long-term cardiovascular outcomes.

Abstract 12950: A Nationwide Remote Patient Intervention Hypertension Program: Can Remote Patient Monitoring and a Multi-Disciplinary Team of Clinicians Improve Blood Pressure Control?

Introduction: Traditional methods for diagnosing and treating HTN, which is the most common modifiable risk factor accounting for ASCVD in the US, have been ineffective. Innovative solutions, like remote patient monitoring (RPM), can transform how we provide longitudinal care for patients with HTN. Hypothesis: An advanced practice provider led HTN program, which leverages RPM and technology-enabled treatment protocols, can provide a scalable solution for optimizing HTN management nationwide. Methods: Cadence is a healthcare technology organization that enrolled patients into a virtual HTN program in PCP clinics in 11 states across the US from February 2022 to April 2023. Eligible patients were Medicare enrollees who had a diagnosis of HTN based on ICD-10 codes, mean blood pressure (BP) &gt;140/90 (using last 3 EMR-based vitals) and were enrolled for at least 30 days. Using daily vitals from a cellular enabled BP cuff and scheduled visits, a team of multidisciplinary clinicians leveraged technology-enabled clinical protocols to facilitate optimization of HTN control. A two-sample t-test was used to detect a difference in mean BP. Results: A total of 4006 patients were enrolled (mean age 73 +/- 9, 70% White) with a baseline BP of 144/83 mmHg. The total reduction in systolic BP (SBP)/diastolic BP (DBP) was 9/6 (p&lt;0.001) in the last week compared to the first week (mean follow-up of 136 +/- 92 days). The total number of vitals recorded, clinical visits and phone calls completed, and high acuity clinical alerts resolved is depicted in Figure 1A. The SBP/DBP reductions by different BP strata are depicted in Figure 1B. There was a ~2x increase in the number patients at goal (BP&lt;130/80) in the last week compared to the first week (31% vs. 15%; p&lt;0.001). Conclusions: A remote patient monitoring HTN program not only can improve the diagnosis of hypertension, but also can significantly reduce blood pressure, and in doing so help more patients achieve guideline recommended BP goals.

Abstract 18538: Results of a Self-Management Intervention to Improve Hypertension in Black Patients Using the Electronic Health Record Patient Portal

Introduction: Nearly half of American adults (47%) have hypertension (HTN), and non-Hispanic Black patients are disproportionately represented among those diagnosed (56% versus 48% for White, 46% for Asian, and 39% Hispanic adults). Models of care to reduce blood pressure for the Black patient population are not consistently implemented, in large part due to systemic and structural barriers to care. Hypothesis: The purpose of this study was to improve access to and use of digital education, skills for self-measured blood pressure (SMBP) monitoring, use of the electronic health record (EHR) patient portal, and blood pressure from baseline to 3 months in a cohort of Black Americans. Methods: A pre-post intervention design was used to evaluate the team-based, nurse-led intervention. Patients received coaching on HTN goals, screening for social determinants of health (SDOH), medication review, self-paced portal-based videos, and teach-back for BP cuff use. Post-implementation blood pressure (BP) and self-management (knowledge, cuff-use, patient portal use, and attendance at follow-up) were measured using the HELM tool, Chronic Care Model (CCM) and American Heart Association (AHA) HTN toolkit. 12-month follow-up is ongoing. Results: Black participants (n=80) averaged 59 (SD 10) years of age; most were female (n=58, 73%), employed (n=59, 75%), non-smokers (n=66, 84%), with average BMI 34.5 (SD8). From 0-3-months, views of portal-pushed videos increased to 69%, knowledge scores improved pre- (M = 67.9, SD = 16.7 to post (M = 75.2, SD = 17.4), and mean systolic BP was significantly reduced by 20.3mmHg (95%CI 16.11, 24.44). Average systolic BP pre was 152.13 (SD = 16.87) and post was 131.85 (SD = 13.13), t (79) = 9.71, p&lt; .001. Sustainability at 12-months is ongoing. Conclusions: A team-based, nurse-led model improves patient engagement, adoption of portal-prescribed education, skills for SMBP, EHR-reported BP, and visit follow-up for Black patients with uncontrolled BP.

Abstract 15558: Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study

Introduction: Abnormal blood pressure (BP) responses during exercise are associated with incident hypertension and cardiovascular disease, but how exercise BP responses relate to average home BP and home BP variability (BPV) over one-year follow-up is unknown. Objective: We investigated whether exercise BP was associated with average home BP and home BPV, after accounting for resting BP, in the electronic Framingham Heart Study (eFHS). We hypothesized that higher exercise BP predicts higher average home BP and home BPV over one-year follow-up. Methods: At a FHS research exam (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing (CPET) with BP measured every two minutes. Participants enrolled in the eFHS were provided with a digital BP cuff to measure home BP weekly for up to one year. Linear regression models were used to examine associations of exercise BP with average home systolic BP (SBP) and week-to-week average real variability (ARV) of home SBP over one-year follow-up, adjusting for covariates. ARV, which considers both the dispersion and order of BP readings, was quantified as the average of the absolute differences between consecutive BP readings. We used p&lt;0.05 for significance. Results: The study sample included 806 participants (mean age 53 years, 58% women, 46% hypertension, median number of home BP returns 22, average home SBP 122 mmHg). Adjusting for resting SBP and other covariates, higher exercise SBP (as measured by peak SBP, SBP at 75 Watts, and SBP/workload slope) was associated with higher average home SBP ( Figure 1A ). Higher SBP/workload slope was associated with elevated ARV of home SBP in men ( Figure 1B ). Conclusion: Higher exercise SBP responses are associated with higher average digital home-based SBP and home-based SBP variability over one-year follow-up after accounting for resting SBP.

Abstract 17939: Predictors of Time in Target Range in a Comprehensive Self-Measured Blood Pressure Program in a Socially and Economically Disadvantaged Primary Care Population

Introduction: The Community Practice Center (CPC) in North Philadelphia serves a community with significant socioeconomic barriers leading to inability to access care necessary for management of hypertension (HTN). Prior studies have shown the efficacy of SMBP programs in improving blood pressure (BP) control. Methods: All sequential patients presenting to the CPC with stage 2 HTN were screened for eligibility. Upon enrollment, patients received a Bluetooth-enabled BP cuff connected to a mobile health app and HTN education. Patients completed validated social and behavioral assessments including social determinants of health (SD)H) assessment via WellRx screen, depression screening (PHQ-9), and self-efficacy screening ( Self-Efficacy to Manage Chronic Disease Scale ). A behavior change plan was created using Brief Problem Solving Therapy based on the aforementioned assessments. Staff continuously monitored usage, BP, and provided individualized interventions. We conducted a cross-sectional quality improvement study using daily BP data from June 2022 - April 2023 to assess the correlation between baseline sociodemographic characteristics and Time in Target Range (TTR) through multivariable linear regression. We calculated TTR, defined as the percentage of time with systolic BP within 100-130 mmHg, through linear interpolation. Results: A total of 133 patients were enrolled in the program. We analyzed data from 78 patients with ≥3 days of readings (average 33; SD 49) and complete baseline characteristics (Table 1). Female sex and non-smoking status were associated with TTR, while diabetes, positive depression screening, positive SDOH screening, and self-efficacy were not (Table 2). Conclusions: In a socioeconomically disadvantaged population participating in a comprehensive SMBP program, depression, SDOH, and self-efficacy screening at time of enrollment did not predict TTR. Participation in a SMBP program may be valuable in these populations.

Standardization of Outpatient Care after CAR-T Therapy across a Large Cell Therapy Network- through Technology and Decentralized Virtual Nurses: Preliminary Results

Introduction: Shifting Chimeric Antigen Receptor T-cell (CAR-T) therapy to the outpatient setting may increase patient satisfaction and inpatient capacity, and reduce infection risk. Outpatient protocols require resources for patient management outside of clinic hours to be safe and effective. Our Transplant and Cellular Therapy Network (TCTN) leveraged wearable technology and decentralized nurses in four outpatient CAR-T programs. We sought to characterize patient adherence, time spent on patient monitoring, and clinical outcomes. Methods: Patients were deemed eligible for outpatient therapy if they were adults (18+ years), lived within 30-60 minutes of the treating hospital, had a 24/7 caregiver, and received CAR-T with known risks of developing cytokine release syndrome (CRS). The outpatient CAR-T program included enrollment into an FDA-cleared virtual care platform, daily engagement with virtual nurses for the duration of the program, and in-person clinic visits during the highest risk period (Days 1-14). The remote monitoring kit included a wearable device that continuously transmitted vital signs (pulse, respiratory rate, O 2 saturation and skin temperature), a tablet, axillary temperature patch and blood pressure (BP) cuff. Patients were asked to always wear the device outside of clinic visits, take a BP reading 3x/day, and complete surveys via the tablet. A multidisciplinary taskforce established clinical pathways for remote monitoring across sites and developed parameters for alarms, virtual nurse check-ins, and escalation of care to ER/clinic. Virtual nurses contacted patients based on vital sign trends, responded to patient concerns, and triaged in accordance with clinical pathways, escalating as appropriate. The virtual care platform, video and phone call logs with the virtual nurses, and clinical data were extracted for 40 patients between 2/20/23 and 6/15/2023. Inpatient admission, patient adherence, alarms, calls, and clinical metrics were summarized. Non-parametric measures were reported as median (IQR). Metrics for specific windows of time were reported for a subset of variables: wearable adherence (day vs. night) and alarms/calls during clinic hours (weekdays 8 am - 5 pm) vs. non- clinic hours. Adherence was derived from tasks/wear time completed vs. prescribed. Results: Forty patients (66 ± 12 years, 24 male) with diagnoses of Non-Hodgkin Lymphoma (75%), Plasma Cell Disorder (20%), or Acute Lymphoblastic Leukemia (5%) received CAR-T therapy [axi-cel (40%), liso-cel (25%), cilta-cel (20%), brexu-cel (12.5%), tisa-cel (2.5%)] and completed the outpatient CAR-T program. The median length of monitoring on the platform was 14.7 (10.4 - 27.6) days. Overall wearable adherence was 79 (67.7 - 87.9) %; 67 (48.7 - 83.4) % in the day and 89.1 (79.8 - 92.8) % at night. Median survey completion was 50 (7.7 - 80) % and BP compliance was 95 (69.8-100) %. Out of 717 patient days, 68.4% had 100% BP compliance (3 readings/day). There was a total of 780 alarms; 67% operational and 86% clinical alarms occurred during non-clinic hours (Table 1). The operational alarm rate was 0.5 and the clinical alarm rate was 0.6 per patient-day. 75% of patients triggered at least one operational and clinical alarm during their program. The virtual nurses engaged in 1102 calls through the tablet or phone (3.5 ± 3.4 mins). More than half of the calls were during non-clinic hours (63%) and 70% of calls were with a patient/care giver. Calls about a clinical alarm or clinical concern were 3x and 6.8x higher, respectively, during non-clinic hours. Twenty-seven patients required some level of hospital observation service and/or admission to the hospital; 25 patients developed CRS. Median duration from infusion to admission/observation was 5 (1-11) days. Median days to discharge was 5 (1-26). Of those admitted,10 patients were admitted to the ICU with a median stay of 5.5 (1-21) days. Conclusion: Our TCTN established a successful, integrated outpatient management process to ensure patient safety within the first 30 days post CAR T-Cell therapy. The virtual care platform and decentralized virtual nurses have enabled patients to recover safely with more time at home rather than in hospital. Future research will address patient and provider experiences and continue to expand on the safety and resource utilization of this integrated program.

Exploring Near Infrared Spectroscopy As a Tool for Monitoring Tissue Hemodynamics for Patients with Sickle Cell Disease

Sickle cell disease (SCD) is a genetic disorder that has higher prevalence in people of African ancestry. In the United States, SCD affects about 100,000 people and 1 in 365 African Americans. Sickled red blood cells (RBCs) have a shorter life span and are rigid, causing chronic hemolytic anemia and vaso-occlusive crises. There is a need for accessible diagnostic and monitoring technologies to characterize hemodynamic health, especially for patients with SCD. Near infrared spectroscopy (NIRS) is a noninvasive optical technique that uses light in the near infrared range (650 - 900 nm) to gain information from tissue absorption and light scattering. The purpose of this study is to show that NIRS is sensitive to differences in tissue hemodynamics between patients with SCD and healthy population. We enrolled adults (age ≥ 18 years) of African descent who were not recently transfused under protocol NCT05604547. Baseline hemodynamics and day-to-day variability were quantified in 10 SCD patients with HbSS (six male, four female) and six healthy, ethnically matched participants (four male, two female). We assessed participants with affixed transmission speckle analysis (ATSA) and a dual system frequency domain-NIRS (FD-NIRS) with diffuse correlation spectroscopy (DCS) device to measure blood flow and hemoglobin concentration. Participants underwent a respiratory challenge, three sets of breath holds, with the optical probe on their forehead. Then, the participants underwent a vascular occlusion challenge, a three-minute brachial blood pressure cuff occlusion at 200 mmHg, with the optical probe on their forearm. We also measured skin and adipose tissue thickness (SATT) of the forearm site with ultrasound. Two of the healthy control participants were excluded from the skeletal muscle analysis due to SATT &amp;gt; 8 mm. A Mann-Whitney significance test was used to evaluate the results. From these measurements, we acquired the concentration of oxygenated (O 2Hb), deoxygenated (HHb), and total hemoglobin (tHb); blood flow index (BFi); and tissue oxygen saturation (StO 2) for cerebral and skeletal muscle. The cerebral StO 2 in the SCD cohort was lower than the control group, 55.5 ± 7.4% versus 66.9 ± 2.5% (p = 0.003), respectively. Skeletal muscle StO 2 in the SCD cohort was lower than that in control, 59.2 ± 5.8% versus 66.4 ± 6.7%, respectively, but the difference was not significant (p = 0.19). The muscle O 2Hb in the SCD cohort was lower compared to control: 32.7 ± 6.5 µM versus 51.0 ± 9.2 µM (p = 0.01), respectively. The muscle tHb had a similar trend, with the SCD cohort measuring 55.8 ± 12.0 µM and the control group measuring 76.5 ± 9.0 µM (p = 0.03). The SCD cohort was also found to have lower overall muscle BFi, averaging 5.37 x 10 -9 ± 3.47 x 10 -9 cm/s, whereas the control group had an average of 1.90 x 10 -8 ± 1.33 x 10 -8 cm/s (p = 0.004). We also calculated hemodynamic markers, such as components of the occlusion recovery. The post-occlusion O 2Hb recovery slope for the SCD cohort was 0.31 ± 0.19 µM/s compared with control group at 1.56 ± 0.75 µM/s (p = 0.004). The goal of this study is to compare baseline vascular hemodynamics between patients with SCD and ethnically matched healthy controls. This study is ongoing and preliminary data analysis suggests impaired cardiovascular health in SCD subjects. The cerebral StO 2, muscle O 2Hb, and tHb in the SCD cohort is hypothesized to be a result of the reduced ability of sickled RBC to carry oxygen. There was a significant difference in the cerebral StO 2 but not in the skeletal muscle StO 2, suggesting that there are more dynamic changes seen in the brain than the muscle. This is consistent with previous work using commercial, continuous-wave NIRS systems for a SCD cohort (Barriteau et al. 2022) that also reported significantly lower cerebral StO 2 and lower trending, but not significant, muscle StO 2 values.The post-occlusion O 2Hb recovery upslope is hypothesized to be slower for the SCD cohort due to reduced endothelial function. We plan to assess repeatability of intra-individual NIRS parameters and to compare the non-invasive hemodynamic metrics to clinical markers, such as blood Hb and echocardiogram. These preliminary results indicate that NIRS is sensitive to changes in hemodynamic variations between SCD patients and healthy controls and, therefore, has the potential to serve as a point-of-care technology for individualized clinical management for patients with SCD.

Alterations of Cerebral Metabolites Are Associated with Frequency of Vasoocclusive Crises and Pain Sensitivity in Patients with Sickle Cell Disease

Purpose Sickle cell disease (SCD) is an inherited hemolytic disorder complicated by acute and chronic pain. Acute vasoocclusive crises (VOCs) associated with SCD are extremely painful episodes that are recurrent, unpredictable, and frequently require hospitalization and opioids for pain control. Changes in brain metabolites were identified in other chronic pain populations but haven't been well studied in SCD. Our ongoing trial (ClinicalTrials.gov Identifier: NCT05045820) aims to evaluate the characteristics of brain metabolites in SCD and understand the relationship between the altered cerebral metabolite(s) and clinical pain in patients with SCD. Materials and Methods Metabolite measurements from a single voxel (size: 2×3×3 cm 3) located within the posterior insula cortex (PIC) were acquired from 26 patients with SCD (31.9 ± 13.9 years, 14-73; 14 females) and 19 healthy controls (HCs) (37.9 ± 16.4 years, 17-62; 10 females) with PRESS (TR/TE = 3000/25 ms, Averages =128) and MEGA-PRESS (TR/TE = 3000/68 ms, Averages =256) sequences using a Siemens Prisma 3T scanner. Written consent was obtained from each participant before scanning. LCModel was used for PRESS analysis to obtain concentration values of glutamine + glutamate (Glx), total creatine (tCr), N-acetylaspartate (NAA), total choline (tCho), and myoinositol (MI). Gannet was used for processing MEGA-PRESS data to estimate GABA+. Ratios of each metabolite to tCr were also quantified. Tissue correction for cerebrospinal fluid was performed for each voxel using the tissue composition estimated from SPM12. The Cramer-Rao Lower Bounds of each metabolite analyzed with LCModel was less than 20%. The frequency of VOCs in the preceding 12 months was recorded for each participant. A moderate pressure pain stimuli (using a 0-100 scale with “0” representing “no pain” and “100” representing “most intense pain imaginable”, pain rating at 40-60 abbreviated as P40 is considered as moderate pain) was delivered via a pressure cuff to the gastrocnemius area of the non-dominant leg using a validated MR-compatible air compressor to induce a tonic pressure pain for 8 min right before MRS scan. Higher pressure intensity (mmHg) of P40 indicated higher pain tolerance and lower pain sensitivity. Correlation between the brain metabolites and pain-related outcomes was studied. Results Due to the large range of age in the SCD group, the brain metabolite profile was compared between 17 SCD patients and 17 ethnicity-, age- and gender-matched HCs. The concentration of Glx (p =0.012) and ratio of Glx to tCr (p =0.034) in PIC were significantly higher in patients with SCD compared to HCs (Figure 1). Within the SCD patient group, there was a significant positive correlation between frequency of VOCs in the preceding 12 months and Glx/tCr (r= 0.39, p=0.047, Spearman's), a significant negative correlation between P40 and Glx (r= -0.46, p=0.019, Spearman's). There were no group differences in any other metabolites. Conclusion We find increased Glx in the PIC in patients with SCD. Previous studies have also found increased Glx and/ or Glx/tCr in the PIC as well as other brain regions including the amygdala, the posterior cingulate, the ventral lateral prefrontal cortex and the anterior insula in fibromyolgia. The PIC is thought to be involved in discriminative activities of sensory pain, which suggests that Glx in PIC is related to pain processing in patients with SCD. Glx/tCr was correlated with frequency of VOCs in patients with SCD, indicating that the SCD patients with higher level of Glx/tCr had more VOCs in the preceding 12 months. In addition, the SCD patients with higher level of Glx had lower pressure intensity of P40, suggesting that elevated Glx in the PIC was related to higher pain sensitivity. Our preliminary data provide the first evidence of a link between alterations in excitatory neurotransmitter levels in the PIC in patients with SCD and indicates new information of potential brain markers for pain in SCD, which may guide treatment. Clinical Relevance Statement: Treatment of pain in SCD remains very challenging in part due to a lack of understanding of the underlying mechanisms and pathophysiology of pain. Brain excitatory neurotransmitters and their relationship with pain have been largely unexplored in SCD. These findings indicate that the relationship between clinical outcomes and excitatory brain neurotransmitters may be a potential objective outcome measure in SCD.

Randomized Trial of a Social Support Intervention to Improve Home Blood Pressure Monitoring in Patients With Cerebrovascular Disease.

A pilot randomized trial evaluating whether a social support intervention improves adherence to home blood pressure (BP) monitoring among patients with cerebrovascular disease. Subjects with ischemic stroke, intracerebral hemorrhage, or transient ischemic attack within 5 years with BP >140/90, were given a centrally monitored home BP cuff and asked to check their BP twice a day for 90 ± 7 days. Subjects received text and/or email reminders for missed measurements and weekly reports on adherence/BP control. Subjects were randomized 1:1 to a social support intervention, in which close personal contact also received all study-related education and communications. The primary outcome was the proportion of requested measurements completed. A secondary outcome was a change in BP over time. Thirty-three subjects were enrolled, 15 in the control arm and 18 in the social support arm. The social support arm completed a greater proportion of BP measurements at day 30 (88% vs 78%), day 60 (72% vs 54%), and day 83 (60% vs 40%), but none of these differences were statistically significant (P > 0.05). Comparing the first 7 days of BP readings to the last 7 days across subjects, there was a nonsignificant decrease in BP over time (systolic BP = -2.8 mm Hg, P = 0.29 and diastolic BP = -1.7, P = 0.36). The social support intervention did not modify the change in BP over time. A social support intervention may increase adherence to home BP monitoring. This pilot study provides important preliminary data to inform the design of larger more definitive trials utilizing self-monitoring of BP in patients with cerebrovascular disease.