Health Topics – Johns Hopkins Medicine Podcasts

A blood pressure monitor, a smart watch, and a smartphone app called Corrie have helped many people avoid another hospitalization after a heart attack, a study by Seth Martin, a cardiologist at Johns Hopkins, and colleagues has shown. Martin says he hopes use of Corrie will continue to grow.

Martin: We can’t force people to use it, ultimately it’s up to the patient but our hope is to inspire as many people as possible to use it. To see the benefits that they could get from engaging with their care with a digital health platform being a medium that really helps organize that and make it a good, positive experience. And so that’s where we’re headed, to really make this part of routine care. And we want to reach everybody, we don’t want this to be for just certain segments of the population that happen to have certain technologies or more comfort for technologies.  :32

Martin predicts that apps like Corrie will soon help people manage much of their health. At Johns Hopkins, I’m Elizabeth Tracey.

Using a smartphone app called Corrie with an Apple watch and a blood pressure monitor helps people being discharged from the hospital feel they are more capable of participating in their own care. That’s according to Seth Martin, a cardiologist at Johns Hopkins and one of Corrie’s developers.

Martin: As patients transitioned home from the hospital they really left more confident about what they needed to do and they would keep interacting with the app, after they left, continuing to learn, continuing to track their medications, tracking blood pressure, and step counts and heart rate. Getting reminders about the follow up appointments that they had, and so forth. And so the emphasis was really on using this for thirty days but our patients did have the option to continue to use it after that study period if desired.  :32

The study demonstrated that people who used Corrie were fifty percent less likely to be readmitted to the hospital within thirty days after their discharge. At Johns Hopkins, I’m Elizabeth Tracey.

Technologies are becoming ever more embedded in healthcare, now enabling people to participate as part of their own healthcare team following a heart attack, with deployment of a smartphone app called Corrie and additional devices. Seth Martin, a cardiologist at Johns Hopkins and one member of the Corrie development team, describes what was needed.

Martin: Provided them with an iPhone if they didn’t have one, we provided an Apple watch, which had the Corrie app on the watch as well so patients could track their physical activity, receive their reminders and so forth on the watch. There was also a companion blood pressure monitor that was part of the intervention. So patients would start using that in the hospital. Patients would then watch educational videos on their phone or stream it to an Apple TV in their hospital room.  :28

Martin predicts that use of an integrated range of devices will become standard of care for people who’ve had a first heart attack, as use of Corrie has been shown to reduce someone’s risk of rehospitalization by fifty percent. At Johns Hopkins, I’m Elizabeth Tracey.

Corrie can help you avoid rehospitalization after you’ve had a heart attack, a study led by Seth Martin, a cardiologist at Johns Hopkins, and colleagues has shown. Corrie is the name of a smartphone app that integrates all aspects of a person’s care as well as providing educational tools so people can become informed participants in their own care.

Martin: The Corrie patients had a fifty percent lower risk of 30 day all cause readmissions compared to patients who were in the historical group that did not use Corrie. We really spanned large academic hospitals as well as more community based hospitals. We also published a cost-effectiveness analysis that really shows the associated of these outcomes with much lower costs of medical care, in fact can result in savings.  :31

Martin says additional studies on various aspects of Corrie’s impact are planned. At Johns Hopkins, I’m Elizabeth Tracey.

Having to come back to the hospital shortly after you’ve been discharged is called rehospitalization, and for people who’ve had a heart attack that’s not an outcome anyone wants. Now an app developed by Seth Martin, a cardiologist at Johns Hopkins, and colleagues, has been shown to help inform and educate people so they can help manage their own care. 

Martin: It’s also about lifestyles, diet and exercise and knowing who to follow up with, knowing about the importance of enrolling in a cardiac rehab program. So as we brought all this together for patients and as they used the app and interacted with Corrie on a smart watch as well as using a connected blood pressure monitor, these high levels of patient activation were associated with improved outcomes, reduced 30 day all cause readmissions. Patients in the Corrie group were less likely to come back to the hospitals.  :31

Martin says using the app, called Corrie, in several types of hospitals has shown its practicality. At Johns Hopkins, I’m Elizabeth Tracey.

Vaccination against the human papilloma virus, or HPV, all but eliminates cervical cancer in those who receive the vaccine early and complete the vaccine series, a study from the UK finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: The overall story is a really good one. They estimated that by June 30 of 2019 there had been 448 fewer cervical cancers that would have otherwise occurred, and 17,000 or more fewer cases of the cancer precursor condition among the girls who had been vaccinated. All told it had almost eliminated cervical cancer in women born since September 1, 1995, in other words the youngest group that got vaccinated.  :30

Nelson says current vaccines are effective against several subtypes of the HPV virus so protection should be even more comprehensive, and notes that boys too should receive the vaccine. At Johns Hopkins, I’m Elizabeth Tracey.

Medicare developed a program to rein in the costs of cancer treatment, but the results were disappointing, a new study reveals, with this comprehensive approach reducing costs by about 1%. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says newer therapies may eventually result in lower costs for cancer care.

Nelson: Thirty percent of the costs of this were for the drugs themselves. I wonder whether the progress towards drugs that are less toxic, hair doesn’t fall out, white blood cell counts don’t drop. Many of them are taken orally, so the expense of delivery is not going to be as great. If we get more people treated earlier in the course of the disease with less toxic therapies, that the other main driver of cost, which is the need for people to show up in emergency rooms, be hospitalized for treatment complications, won’t slowly but surely be less and less. :31

As cancer cases rise worldwide, developing approaches to contain costs is critical. At Johns Hopkins, I’m Elizabeth Tracey.

The Covid-19 spike protein allows it to attach to cells and infect them, and it’s been a primary target for vaccines and antibodies. Now a new monoclonal antibody directed against a region of this protein that really doesn’t change very much has been developed, and Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says that’s great, but there are still barriers to treatment.

Garibaldi: While its easier to administer something subq or intramuscular, you still have to watch people for potential infusion or injection site reactions and the biggest challenge right now is space and staff.  We’ve seen critical shortages at all levels of healthcare. Remember these are all for the most part patients who are going to have Covid. So you have to have a designated space in an already busy healthcare environment to administer that drug. I think that’s led to a lot of health systems not being able to keep up with the demand.  :28

Garibaldi says this antibody should be useful against more variants of Covid-19. At Johns Hopkins, I’m Elizabeth Tracey.

Another monoclonal antibody against Covid-19 has been developed and appears to work in reducing severe disease and hospitalization. This one is unique, however, according to Brian Garibaldi, a critical care medicine expert at Johns Hopkins.

Garibaldi: The interesting thing about the new monoclonal antibody, sotrovimab, this monoclonal antibody was developed using antibodies from individuals who were infected with Sars-CoV1. It targets a more conserved region of the spike protein and the hope would be that this type of monoclonal antibody would be less likely to come across viruses that are resistant to its action. So far we have not seen delta being resistant to the other currently available monoclonals but you can imagine that we might encounter a variant down the road that might be.  :29

Garibaldi says monoclonal antibodies are still limited to those who come forward for treatment within a few days of infection, and must be administered in settings that allow for observation as well as protection of others from Covid-19. At Johns Hopkins, I’m Elizabeth Tracey.

Monoclonal antibodies remain a treatment option for those in early stages of Covid infection, even in the face of new oral medications that likely will be available soon. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, says the data are persuasive.

Garibaldi: High risk individuals who are household contacts of people who have documented Covid, they got randomized to getting subcutaneous administration of monoclonals versus placebo. At a month it was about 80% effective in symptomatic infection. Eight months after that initial prophylactic infusion protection still holds to about 80%. So it’s likely that people who get monoclonal antibodies these antibodies are going to circulate at pretty high concentrations for months. We currently recommend that you don’t get vaccinated until 90 days past your initial monoclonal antibody infusion.  :31

Garibaldi notes that monoclonals are not a substitute for vaccination, however, so when you are eligible to receive the vaccine you should do so. And monoclonals require supervised administration and observation afterward. At Johns Hopkins, I’m Elizabeth Tracey.