Using Telehealth to Disseminate Primary, Secondary, and Tertiary CVD Interventions to Rural Populations

  • Helene VilmeEmail author
  • Naomi N. Duke
  • Charles Muiruri
  • LaShawn Wordlaw
  • Asheley C. Skinner
Telemedicine and Technology (HB Bosworth, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Telemedicine and Technology


Purpose of Review

This study aims to review the evidence on telehealth interventions in rural communities that use primary, secondary, or tertiary strategies for the prevention and management of cardiovascular disease (CVD).

Recent Findings

Studies focused on the reduction of CVD risk factors and mitigation of disease progression among rural populations using telehealth are limited in number but appear to be increasing in the last 5 years. These studies suggest primary-, secondary-, and tertiary-level interventions can impact CVD risk and management. The current review found more studies addressing primary CVD intervention strategies, although the evidence for efficacy at all intervention levels is in the early stages.


Leveraging prevention strategies via telehealth may be an effective vehicle to facilitate improved CVD outcomes among populations traditionally marginalized by geographic location.


Primary prevention of cardiovascular disease Secondary prevention of cardiovascular disease Tertiary prevention of cardiovascular disease Rural health Cardiovascular disease (CVD) Health disparities 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    National Center for Health Statistics. Cardiovascular disease Mortality rural-urban differences. Hyattsville: Centers for Disease Control and Prevention. Accessed 16 June 2019
  2. 2.
    MacQueen IT, Maggard-Gibbons M, Capra G, Raaen L, Ulloa JG, Shekelle PG, et al. Recruiting rural healthcare providers today: a systematic review of training program success and determinants of geographic choices. J Gen Intern Med. 2018;33(2):191–9. Scholar
  3. 3.
    Rural Health Information Hub. Healthcare access in rural communities. Accessed 16 June 2019.
  4. 4.
    Office of Disease Prevention and Health Promotion (ODPHP). Healthy people 2020 leading health indicators, 2019. Accessed 24 August 2019.
  5. 5.
    Giedrimiene D, King R. Abstract 207: burden of cardiovascular disease (CVD) on economic cost. Comparison of outcomes in US and Europe. Circ Cardiovasc Qual Outcomes. 2017;10(suppl_3):A207-A. Scholar
  6. 6.
    White LA, Krousel-Wood MA, Mather F. Technology meets healthcare: distance learning and telehealth. Ochsner J. 2001;3(1):22–9.PubMedPubMedCentralGoogle Scholar
  7. 7.
    •• American Hospital Association. Rural report, 2019. Accessed 24 August 2019. This report highlight the chalenges facing rural communities and the roadmap to encure local access to high-quality, affordable care.
  8. 8.
    Centers for Disease Control and Prevention. Picture of America_Prevention. Accessed 8 July 2019.
  9. 9.
    Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2014;30(1):79–88. Scholar
  10. 10.
    Davis RM, Hitch AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ. TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare. Diabetes Care. 2010;33(8):1712–7. Scholar
  11. 11.
    Ciemins E, Coon P, Peck R, Holloway B, Min SJ. Using telehealth to provide diabetes care to patients in rural Montana: findings from the promoting realistic individual self-management program. Telemed J E Health. 2011;17(8):596–602. Scholar
  12. 12.
    Resnick HE, Ilagan PR, Kaylor MB, Mehling D, Alwan M. TEAhM-technologies for enhancing access to health management: a pilot study of community-based telehealth. Telemed J E Health. 2012;18(3):166–74. Scholar
  13. 13.
    Shane-McWhorter L, Lenert L, Petersen M, Woolsey S, McAdam-Marx C, Coursey JM, et al. The Utah remote monitoring project: improving health care one patient at a time. Diabetes Technol Ther. 2014;16(10):653–60. Scholar
  14. 14.
    Young H, Miyamoto S, Ward D, Dharmar M, Tang-Feldman Y, Berglund L. Sustained effects of a nurse coaching intervention via telehealth to improve health behavior change in diabetes. Telemed J E Health. 2014;20(9):828–34. Scholar
  15. 15.
    • Litke J, Spoutz L, Ahlstrom D, Perdew C, Llamas W, Erickson K. Impact of the clinical pharmacy specialist in telehealth primary care. Am J Health Syst Pharm. 2018;75(13):982–6. This research study focused on leveraging clinical pharmacy specialist to provide primare comprehensive medication management services soley via telehealth. Since there are shortages of physicians in rural communities, leveraging other healthcare providers to help improve disease management is an important contribution to the literature on telehealth. CrossRefPubMedGoogle Scholar
  16. 16.
    Gore MO, Krantz MJ, Albright K, Beaty B, Coronel-Mockler S, Bull S, et al. A controlled trial of mobile short message service among participants in a rural cardiovascular disease prevention program. Prev Med Rep. 2019;13:126–31. Scholar
  17. 17.
    Anderson ER, Smith B, Ido M, Frankel M. Remote assessment of stroke using the iPhone 4. J Stroke Cerebrovasc Dis. 2013;22(4):340–4. Scholar
  18. 18.
    Lazaridis C, DeSantis SM, Jauch EC, Adams RJ. Telestroke in South Carolina. J Stroke Cerebrovasc Dis. 2013;22(7):946–50. Scholar
  19. 19.
    Chapman Smith SN, Govindarajan P, Padrick MM, Lippman JM, McMurry TL, Resler BL, et al. A low-cost, tablet-based option for prehospital neurologic assessment: the iTREAT study. Neurology. 2016;87(1):19–26. Scholar
  20. 20.
    Al Kasab S, Adams RJ, Debenham E, Jones DJ, Holmstedt CA. Medical University of South Carolina Telestroke: a telemedicine facilitated network for stroke treatment in South Carolina-a Progress report. Telemed J E Health. 2017;23(8):674–7. Scholar
  21. 21.
    Barnason S, Zimmerman L, Schulz P, Pullen C, Schuelke S. Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: a randomised trial. J Clin Nurs. 2019;28(9–10):1808–18. Scholar
  22. 22.
    •• Wolf SL, Sahu K, Bay RC, Buchanan S, Reiss A, Linder S, et al. The HAAPI (Home Arm Assistance Progression Initiative) trial: a novel robotics delivery approach in stroke rehabilitation. Neurorehabil Neural Repair. 2015;29(10):958–68. Access to care is a barrier for patients in rural communities. This study is the first to systematically assess the efficacy and feasibility of a robotic telerehabilitation intervention to improve post-stroke patients with limited access to rehabilitation services upper-extemity function capabilities. This is an important contribution to science. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Karunathilake SP, Ganegoda GU. Secondary prevention of cardiovascular diseases and application of technology for early diagnosis. Biomed Res Int. 2018;2018:5767864. Scholar
  24. 24.
    Hobbs FD. Cardiovascular disease: different strategies for primary and secondary prevention? Heart. 2004;90(10):1217–23. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Helene Vilme
    • 1
    Email author
  • Naomi N. Duke
    • 2
  • Charles Muiruri
    • 1
    • 3
    • 4
  • LaShawn Wordlaw
    • 5
  • Asheley C. Skinner
    • 1
  1. 1.Department of Population Health SciencesDuke University School of MedicineDurhamUSA
  2. 2.Internal Medicine, Pediatrics, Adolescent Medicine, Division of Primary Care, Department of PediatricsDuke UniversityDurhamUSA
  3. 3.Kilimanjaro Christian Medical University CollegeMoshiTanzania
  4. 4.Department of Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillUSA
  5. 5.Department of Public Health EducationNorth Carolina Central UniversityDurhamUSA

Personalised recommendations