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Evaluation of an Integrated, Digital, Nurse-led, Remote Monitoring Care Pathway for Cardiovascular Risk Management

Evaluation of an Integrated, Digital, Nurse-led, Remote Monitoring Care Pathway for Cardiovascular Risk Management

Recruiting
18 years and older
All
Phase N/A

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Overview

The goal of this observational study is to evaluate the implementation of a structured, digital, nurse-led, remote monitoring care pathway for cardiovascular risk management (CVRM). Participants will receive this care as part of routine clinical practice. In addition to standard follow-up, participants will complete questionnaires on quality of life, medication adherence, system usability, and patient satisfaction.

Description

CVRM is essential for patients at increased risk of cardiovascular disease (CVD) as well as for those with established atherosclerotic cardiovascular disease (ASCVD). Monitoring blood pressure and lipid profiles is crucial to achieving guideline-recommended targets. However, many patients fail to reach these targets despite the availability of effective therapies, resulting in an increased risk of recurrent events. Meanwhile, the burden of CVD continues to rise, creating significant pressure on healthcare systems.

A digital care pathway may improve therapy adherence and outcomes by enabling personalized, data-driven care. This study evaluates the effectiveness of a nurse-led, telemonitoring pathway for CVRM in routine practice, where patients measure their blood pressure and LDL-c levels at home. The study aims to improve risk stratification, support earlier intervention, and optimize lipid and blood pressure control, ultimately leading to better patient outcomes.

Eligibility

Inclusion Criteria:

  • Age ≥18 years
  • All patients enrolled in the program (high-risk and very high-risk patients)

Exclusion Criteria:

  • Not able to provide informed consent
  • No access to smartphone and/or tablet
  • Inability to use digital tools required for the program

Study details
    Atherosclerotic Cardiovascular Disease (ASCVD)
    Hypertension
    Dyslipidemia

NCT07208331

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

21 October 2026

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