2022 Q1 Clinical Update

I’m pleased to report the clinical outcomes for patients where Cardiology practices prescribed the Nudj Health program. These are patients with common cardiac diagnoses such as hypertension, atrial fibrillation, etc., treated in the stress management and insomnia arms of our Collaborative Care treatment pathway. This is specifically relevant because of recent AHA scientific statements and advisories correlating lifestyle choices, psychological health and risk modification with cardiovascular disease.^1,2

To assess depression, anxiety, and insomnia we use the following clinical assessment tools: Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI). Please see Fig. A for more information on the scoring of each assessment.³

The average initial depression, anxiety, and insomnia scores fall into the mild category for each assessment. After at least four weeks in treatment, scores decrease approximately 30%. We see continued improvements in scores at weeks 8 and 12 such that patients are only one point away from the “no disease” categories in all three assessments. This is a clinically meaningful decrease and results in improved quality of life, relationships, and activities.

A subset analysis of patients with scores in the moderate-severe ranges reveals even more significant and rapid improvements after initiating care with Nudj Health. After four weeks of treatment, patient depression scores improve 41%, anxiety scores decrease 47%, and insomnia scores 36%. During the subsequent weeks of treatment, scores continue to improve such that by at least 12 weeks of treatment, depression scores have decreased 51%, anxiety scores decreased 58.4%, and insomnia scores decreased 39%. For these patients whose disease significantly impacted their life, treatment unlocked emotions and experience they once felt were denied to them such as joy, social connection, and improved health and well-being.

In behavioral health, industry-wide accepted treatment targets are defined as a 50% reduction in scores or reaching remission of disease. Using this benchmark, our treatments prove effective and remarkably efficient and meet or exceed the treatment standards for Collaborative Care set by the University of Washington AIMS Center. Research suggests that typical time to a 50% reduction in scores or remission of disease in typical outpatient behavioral health settings is 87 weeks.⁴

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

Sincerely,

Katie Hill, MD
CMO

References

1. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (01.25.21)
2. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association (06.29.22)

3. Figure A - Screening Scores

   Depression (PHQ-9)
   0-4	Minimal depression
   5-9	Mild depression
   10-14	Moderate depression
   15-19	Moderately severe depression
   20-27	Severe depression

   Anxiety (GAD-7)
   0-4	Minimal anxiety symptoms
   5-9	Mild anxiety symptoms
   10-14	Moderate anxiety symptoms
   15-21	Severe anxiety symptoms

   Insomnia (ISI)
   0-7	No clinically significant insomnia
   8-14	Mild, sub threshold insomnia
   15-21	Moderate, clinical insomnia
   22-28	Severe, clinical insomnia

4. Gregory M. Garrison, Kurt B. Angstman, Stephen S. O'Connor, Mark D. Williams and Timothy W. Lineberry. The Journal of the American Board of Family Medicine January 2016, 29 (1) 10-17; DOI: https://doi.org/10.3122/ jabfm.2016.01.150128