Preventive Medicine

Brain disease and heart disease are the leading causes of death and disability in the US; at least 60% of cases can be attributed to modifiable risk factors such as hypertension, dyslipidemia, and poor-quality diet. Our mission is to deliver high-quality preventive care to whole geopolitically defined communities, reaching every resident. ThumpThump is a novel implementation strategy that 1) uses sociology, marketing, and behavioral science to engage residents and 2) adapts population health methods from high-functioning health systems to geopolitically defined communities. ThumpThump is starting with hypertension in Derby, CT in collaboration with city residents and city leaders. The ThumpThump Pilot Study will estimate the likelihood that a large, definitive trial of ThumpThump can succeed. The pilot study will enroll 150 residents who are at least 40 years of age. Specific aims are: 1) demonstrate ThumpThump can reach residents of Derby, 2) measure and achieve fidelity to standard hypertension care, and 3) measure success in applying our implementation strategy. The pilot is a one-arm trial. Proven population health methods from high-functioning health systems will be used to first classify participants according to hypertension (none, controlled, uncontrolled) and then help those in need get to goal. Home blood pressure cuffs will be given to all participants. Participants with no or controlled hypertension will have blood pressure re-measured at three and six months. Participants with uncontrolled hypertension will be offered two options: 1) to continue care from their personal healthcare professional or 2) to receive hypertension care directly from our team. With either method, the study will continue to monitor their blood pressure regularly. If they continue to receive care from their personal professional, participants will be offered support in following that professional's plan and the study will communicate and coordinate with their professional as appropriate. If they chose our team, a treatment algorithm will be used to help them get to their BP goal. Community health workers will be employed for participant enrollment and follow-up care (e.g., health education, blood pressure monitoring, treatment implementation, and navigation within health systems). Team care will include working with local health care professionals and institutions to advance a mutual mission, not replace their function. If successful, funds for a definitive trial will be sought with the long-term goal of targeting more risk factors and expanding to more communities.

Acute renal injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. It is now realized that intraoperative hypotension is an important risk factor for the development of AKI. In a recent randomized controlled trial of patients undergoing major noncardiac surgery, intraoperative individualized blood-pressure management reduced the incidence of postoperative organ dysfunction. The investigators hypothesize that, for patients undergoing off-pump CABG, targeted blood-pressure management during surgery may also reduce the incidence of postoperative AKI.