Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized Controlled Trial of Telemonitoring Versus Usual Care in a High Risk Elderly Population.
Brief Summary: Background: Older adults with multiple chronic illnesses are at risk for worsening functional and medical status with ensuing hospitalization. One goal of medical care is to prevent this decline. One method that may help slow this functional and medical decline is home telemonitoring.

Specific aim: To determine the effectiveness of home telemonitoring compared to usual care in reducing combined outcomes of hospitalization and emergency room visits in an at risk population over 60 years of age.

Materials and Methods: This will be a randomized trial of 200 patients into one of two interventions. Home telemonitoring involves the use of a computer device at home which records biometric and symptom data from patients. This information is monitored by mid level providers associated with the primary care medical practice. Usual care involves patients who make appointments with their providers as problems arise and utilize ongoing support like a 24 hours nurse line. The study participants are adults over 60 years of age within the highest 10% on elderly risk assessment (ERA) scores. Patients will have initial evaluations of gait, quality of life (SF12), Kokmen test of mental status, and PHQ 9. Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency room visits. Secondary analysis will include quality of life, compliance with the device and attitudes about telemonitoring. Sample size is based upon an 80% power to detect a 36% difference between the groups. The primary analysis will involve Cox proportional time to event analysis comparing both interventions for telemonitoring or usual care. Secondary analysis will use T-test comparisons for continuous variables (quality of life, attitudes) and chi square for proportional analysis.


Options:
A: Inclusion Criteria:

1. Diagnosis of HF ≥ 3 months, with either preserved or reduced LVEF
2. Diagnosis of NYHA Class III HF (historical assessment documented at screening visit)
3. Subjects with reduced LVEF must be receiving a beta blocker for 3 months and an ACE-I or ARB for one month unless in the investigator's opinion, the subject is intolerant to beta blockers, ACE-I or ARB. Beta blockers and ACE-I (or ARB) doses should be stable for one month prior to study entry.
4. At least 1 HF hospitalization within 12 months of Screening Visit
5. Subjects with pulmonary artery branch diameter sized between 7mm and 15mm (implanted vessel)

Exclusion Criteria:

1. Subjects with history of recurrent (\> 1) pulmonary embolism or deep vein thrombosis
2. Subjects, in the Investigator's opinion, unable to tolerate a right heart catheterization
3. Subjects who have had a major cardiovascular event (e.g., myocardial infarction, stroke) within 2 months of Screening Visit
4. Subjects with Cardiac Resynchronization Device (CRT) implanted ≤ 3 months prior to enrollment
5. Subjects with a Glomerular Filtration Rate (GFR) \<25 ml/min who are non-responsive to diuretic therapy or who are on chronic renal dialysis
6. Subjects likely to undergo heart transplantation within 6 months of Screening Visit
7. Subjects with congenital heart disease or mechanical right heart valve(s)
8. Subjects with known coagulation disorders
9. Subjects with a hypersensitivity or allergy to aspirin, and/or clopidogrel
B: Inclusion Criteria:

* Patients presenting to Rural Emergency Department within 12 hours of acute stroke symptom onset.
* Written informed consent.

Exclusion Criteria:

* Unlikely to complete study through 90-day follow-up.
C: Inclusion:

1. at least 60 years of age;
2. have an Elder Risk Assessment (ERA) Index score of 16 or greater;
3. Are able to participate fully in all aspects of the study;
4. Have been provided with, understand, and have signed the informed consent;

Exclusion:

1. patients who are currently residing in a nursing home
2. patients with a clinical diagnosis of dementia
3. patients with a score of ≤29 on the Kokmen short test of mental status
4. patients for whom we cannot obtain informed consent.
5. patient under the age of 60 will also be excluded from participating.
6. patients who have not granted Universal Research Authorization to use medical records.
7. patients will also be excluded if the subject would not be able to use the interventional machine
D: Inclusion Criteria:

* Age 21 years or more
* Linked using EMR data to a HealthPartners Medical Group primary care clinic
* Within the 12-month period of time prior to screening have had at least 2 primary care outpatient encounters, in the two most recent of which the blood pressure was above Joint National Committee 7 (JNC7) goal (\<140/90 mmHg or \<130/80 for patients with diabetes or kidney disease).
* Have a measured blood pressure at a research clinic screening visit above the JNC7 goal

Exclusion Criteria:

* Acute coronary syndrome or stroke within the past 3 months
* Class III (marked limitation of physical activity) or IV (symptoms at rest) New York Heart Association heart failure, or known left ventricular ejection fraction (\<30%)
* Severe renal dysfunction, with epidermal growth factor receptor (eGFR) ,30 ml/min/1.73 m2 using the abbreviated Modification of Diet in Renal Disease Study (MDRD) equation
* Known secondary causes of hypertension such as coarctation of the aorta, pheochromocytoma, adrenal cortical hypertension or renal vascular hypertension
* Unwillingness to be followed for a period of 18 months
* Pregnancy or unwillingness to use reliable bith control for females of child-bearing age
* Participation in another clinical trial
* Requires an interpreter to communicate with health care providers
* Dementia, mental illness or any condition that would limit ability to give informed consent

Answer: C