2022 Q2 Clinical Update

I’m pleased to give an update on the clinical outcomes for patients where Cardiology practices prescribed the Nudj Health program. This update shares information on patients treated in the nutrition and fitness arms of our Collaborative Care treatment pathway. Our treatment is focused on aiding patients achieve improved lifestyle choices and psychological health to improve their risk of cardiovascular disease and to improve health and well-being over time, as recommended by recent AHA guidelines.^1,2

In the nutrition pathway (N=135), care is delivered by a Registered Dietician with follow up by a health coach. To assess overall nutrition, we use “Starting the Conversation,” a validated screening tool and metrics such as weight, blood pressure, and common laboratory values such as hemoglobin A1c (HbA1c) and lipids. Participants choose one or more goals upon starting the program such as weight loss (75%), blood pressure control (20%), HbA1c control (12.6%), etc. For all the following outcomes, participants were in treatment at least 60 days. Average initial weight decreased from 201.2lbs to 194.5lbs, or a loss of 6.7lbs (N=60). Average blood pressure decreased from 136.9/80.4 to 127.9/76.3 mm Hg, or a decrease of 9.1 mm Hg systolic and 4.5 mm Hg diastolic (N=19). Average HbA1C decreased from 7.18 to 6.3 (N=5). Average cholesterol decreased from 186.2 to 175.6 (N=5). Average triglycerides decreased from 220 to 129.2 (N=6). The completion rate was 83.7% for a variety of reasons.

In the fitness pathway (N=78), patients are assessed by a fitness expert who has been trained by a physical therapist. Based on the initial assessment, patients are placed into categories of ability and start a 12-week program designed by the physical therapist and tailored to ability level. Patients have follow-up by health coaches and assessments by fitness team experts. Patients can advance through multiple program levels upon meeting level benchmarks. For all the following outcomes, participants were in treatment at least 60 days. Average minutes of daily exercise increased 71.5% from 8.6 to 30.2 and average days per week with exercise increased 62.2% from 1.7 to 4.6 (N=18). Average seconds for the Five-Times-Sit-to-Stand-Test decreased from 14.2 to 10.2 (N=20). The completion rate was 75% for a variety of reasons.

The nutrition pathway proves to be the most challenging to deploy. While the majority of patients listed weight loss as their primary goal, weight loss was only 6.7lbs. The CDC defines a healthy weight loss rate of 1-2 pounds per week, and using this as a benchmark, we would prefer to see weight loss of 10-15 pounds in a similar period. This 10% of body weight loss is far more significant in terms of risk reduction. However, we are very encouraged the blood pressure group showed significant improvements with average initial measures meeting criteria for grade 1 hypertension and decreasing to measures meeting criteria for normal blood pressure and thus lowering risk for hypertension-mediated organ damage over time.³ Similarly, HbA1c values decreased significantly from levels diagnostic of diabetes to those of pre-diabetes, albeit with smaller numbers of patients. Future program improvements will be aimed at modifying the nutrition program to improve weight loss outcomes.

The physical fitness pathway demonstrates excellent efficacy with 71.5% increase in minutes of exercise per day and a 62.2% increase in days per week with exercise, meeting U.S. nationally recommended physical activity guidelines for older adults with multiple chronic health conditions with a mix of strength training, balance training, and aerobic activities.⁴ The Five-Times-Sit-to-Stand-Test is a good proxy for lower extremity strength and balance, which also improves significantly among our patients.⁵ With initial scores in the sedentary range, and scores after 60 days being nearly at the recommended 150 mins of weekly exercise, our patients are decreasing their risk of allcause mortality, heart disease, stroke, hypertension, cancer, type 2 diabetes, obesity, osteoporosis, fall-risk, Alzheimer’s disease, etc. They are also increasing their quality of life.

We remain committed to delivering efficient and highly effective clinical care with the aim of improving health and well-being. For the full details of our analysis, please see the information below.

Sincerely,

Katie Hill, MD
CMO

References

1. Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021 Mar 9;143(10):e763-e783.
2. Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W; American Heart Association. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022 Jun 29:101161CIR0000000000001078.
3. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hyperten. 2020:38(6):984.
4. U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. Retrieved from https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf
5. Teo TW, Mong Y, Ng SS. The repetitive Five-Times-Sit-To-Stand test: its reliability in older adults. International Journal of Therapy and Rehabilitation. 2013 Mar 2;20(3):122-30.