This document describes a proposed intervention to improve cardiovascular event risk in non-English speaking patients with hypertension through better blood pressure control. The intervention would use a bioinformatics tool to identify eligible patients and provide specialized counseling with an interpreter to discuss hypertension management before discharge. The goal is to lower systolic blood pressure and reduce absolute risk of cardiovascular events, as measured by comparing blood pressure at admission, 2-week, and 6-month follow-up visits. The intervention aims to address language barriers that can negatively impact medication adherence and health outcomes.

1. Improving Cardiovascular Event Risk
Through Blood Pressure Control in
Non-English Speaking Patients
Jacob Fleming
Foundations in Healthcare Delivery
Public Health and Prevention
Candidate for Degree of MD
Vanderbilt University School of Medicine
08/28/2016

2. Case
• 57 y/o Black Female w/ chest pain
• PMH
– Deaf; uses sign language
– DMII, HTN, HLD, GERD, COPD, non-obstructive
CAD
• SH: never smoker
• FH: DVT in daughter and mother

3. Case (cont.)
• PE: BP 170/90, HR 70, RR 18, BMI 34.4
– CV: NRRR, no MRG
– Lungs: CTAB, non labored
– Abdomen: obese, nontender, normal bowel sounds
Labs:
– Total cholesterol 129; HDL 35
• Medications: spironolactone, linsinopril,
amlodipine, carvedilol, atorvastatin, metformin,
insulin

4. ASCVD Risk Calculation
• Calculated with BP at admission…
– HDL 35
– Total Cholesterol 129
– SBP 170
– Diabetes, HTN, no smoking
ASCVD RISK: 10 years = 32.1%
• Calculated with BP later in admission…
– HDL 35
– Total Cholesterol 129
– SBP 133
– Diabetes, HTN, no smoking
ASCVD RISK: 10 years = 22.4%
Based on the ASCVD calculator, proper BP control for this patient
confers at absolute risk reduction of 7.7%, or relative risk reduction of
24%.

5. What demographic factors are at work here?

6. https://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-
Statistics_UCM_319064_SubHomePage.jsp

10. Project: Target Population
• Non-English speaking patients with HTN

11. Target of Risk Reduction:
Consistent BP Improvement
• Why:
– Chronic HTN drastically elevates risk of CV events.
– There are many options for medical control of BP
available based on patient needs (e.g. cost,
concomitant diabetes).
– Non-English speaking patients may be at
increased risk for medical noncompliance 2/2
poor comprehension of HTN and the need for
daily medication.

12. Planned Intervention:
Special Counseling Session with Non-English Speaking
Patients with Poorly Controlled HTN (SBP>140) on
Admission
• Bioinformatics Tool to “Tag” Patients
• Hire a bioinformatics specialist to create a screening algorithm to
identify patients on admission who are:
– Non-English speaking
– Have SBP > 140 on admission (require two measurements to confirm)
• The tool will notify physicians and nursing staff of the criteria met
for this patient.
– Special Training for Pharmacist to Counsel on HTN Control
• Before discharge, a specially trained pharmacist, along with an
interpreter, will meet with the patient to discuss HTN control.
• SBP will be measured at F/U outpatient visits; 2 weeks and 6
months.

13. Metric to Determine Improvement
• 1) SBP* at admission
• 2) SBP* at F/U appointment
– Patient will F/U at 2 weeks, then 6 months
*in Non-English speaking population, with SBP>140
mm Hg at admission

14. Time Course Needed
• 6 months
– To assess number of cases that have been
admitted meeting criteria; statistically different
from overall population?
• 1 year
– To assess average change in SBP from initial
admission to 1st and then 2nd outpatient F/U

15. Defense
• Language barriers cause trouble for patients,
physicians, and other team members.
• Medication reconciliation and counseling are
difficult and time consuming; non-English speakers
may require additional counseling time.
• Software automation can help identify and “tag” at-
risk patients and involve a specially trained
counseler.
• The growing minority population in the US portends
a greater need for counseling of non-English
speakers in healthcare.