Exploring the effect of telemedicine on the control of blood pressure and lipid measurements in cardiovascular patients from rural Sweden: a before-and-after intervention study

Introduction: Compliance with long-term secondary prevention guidelines in primary care settings is hampered, in part, by a shortage of health professionals in rural areas. Telemedicine has shown promise in supporting preventive care without requiring the physical relocation of professionals to underserved regions. Although many studies have shown positive outcomes with telemedicine, more evidence is needed. The aim of this study was to compare the effect of telemedicine on compliance to guidelines for blood pressure and lipid control in primary care in patients with ischaemic cardiovascular disease compared with traditional care in rural Sweden. In addition, the study investigated the effect of five years of telemedicine follow-up on improvements in blood pressure and lipid levels compared with a control health centre. Methods: Two rural health centres in northern Sweden were included. The intervention group received regularly scheduled online video consultations between a cardiologist and the local nurses, while the control group received conventional centre-based monitoring. Patient-based registry information was collected for the period 2016-2020. Data included available measurements of systolic and diastolic blood pressure, LDL, HDL, total cholesterol and triglycerides. Compliance with the guidelines was assessed by recording the number of available blood pressure and lipid measurements from the list of eligible patients. Those with one or no measurements were considered non-compliant. Means of blood pressure and lipid measurements at two time points were estimated, followed by difference-in-difference analysis. Results: The intervention group showed increased compliance to guideline recommendations. However, there were no statistically significant differences in blood pressure and lipid measurements over time compared with the control group. Conclusion: The results highlight the potential of telemedicine to improve compliance to secondary cardiovascular prevention guidelines in rural primary care. This study serves as a successful model for integrating telemedicine into real-world healthcare and highlights the need for continued research and evaluation.