Community Paramedicine and Mobile Integrated Health for Cardiovascular Risk and Heart Failure An Analysis and Synthesis of Evidence on Outcomes
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Abstract
The objective of this narrative review was to synthesize evidence on how community paramedicine and mobile integrated health programs have been implemented to assess and manage cardiovascular risk and heart failure in community and home-based settings, and to assess reported effects on health care utilization, adherence-related outcomes, and feasibility of care delivery. PubMed/MEDLINE was searched for English-language, human-subject literature published from January 2016 through January 2026, with the final search completed February 28, 2026. Eligible studies described community paramedicine or mobile integrated health interventions addressing cardiovascular risk assessment, heart failure-related monitoring, or cardiopulmonary post-discharge care in community or home-based settings and reported patient-level clinical, utilization, adherence, feasibility, or implementation outcomes. Studies focused exclusively on non-cardiovascular conditions, emergency response-only care, protocols, conference abstracts, non-peer-reviewed reports, or program descriptions without outcomes were excluded. The search identified 44 PubMed/MEDLINE records, and citation linking identified 12 additional records. Twenty-nine sources were included, including eight core empirical studies prioritized for model-based synthesis. No formal risk-of-bias tool was applied; study quality was considered narratively according to design, comparison group, sample size, follow-up duration, outcome definition, and potential confounding. Three intervention models predominated: post-discharge home-based follow-up, community-based screening and linkage, and high-utilizer home-visit programs. Post-discharge follow-up demonstrated heterogeneous effects on utilization, with more consistent reductions in targeted, higher-risk populations and programs with defined visit frequency and escalation pathways. Screening programs showed improvements in intermediate cardiovascular risk factors and modest reductions in emergency medical services use, although downstream utilization effects were variable. Feasibility of paramedic-led cardiovascular assessment and follow-up was consistently demonstrated. Results highlight the need for future research to clarify the effectiveness of community paramedicine and mobile integrated health programs in cardiovascular care. Key limitations include single-database searching, single-reviewer screening, and absence of formal risk-of-bias assessment.
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References
Abrashkin, K. A., Poku, A., Ramjit, A., Washko, J., Zhang, J., Guttenberg, M., & Smith, K. L. (2024). Community paramedics treat high acuity conditions in the home: A prospective observational study. BMJ Supportive & Palliative Care, 14(e1), e683–e690. https://doi.org/10.1136/bmjspcare-2018-001746
Agarwal, G., Angeles, R., Brar, J., Pirrie, M., Marzanek, F., McLeod, B., & Thabane, L. (2024). Effectiveness of the community paramedicine at home (CP@home) program for frequent users of emergency medical services in Ontario: A randomized controlled trial. BMC Health Services Research, 24(1), 1462. https://doi.org/10.1186/s12913-024-11952-7
Agarwal, G., Angeles, R., Pirrie, M., Marzanek, F., McLeod, B., Parascandalo, J., & Dolovich, L. (2016). Effectiveness of a community paramedic-led health assessment and education initiative in a seniors’ residence building: The Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). BMC Emergency Medicine, 17(1), 8. https://doi.org/10.1186/s12873-017-0119-4
Agarwal, G., Angeles, R., Pirrie, M., McLeod, B., Marzanek, F., Parascandalo, J., & Thabane, L. (2018). Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: A cluster randomized trial. Canadian Medical Association Journal, 190(21), E638–E647. https://doi.org/10.1503/cmaj.170740
Agarwal, G., Angeles, R., Pirrie, M., McLeod, B., Marzanek, F., Parascandalo, J., & Thabane, L. (2019). Reducing 9-1-1 emergency medical service calls by implementing a community paramedicine program for vulnerable older adults in public housing in Canada: A multi-site cluster randomized controlled trial. Prehospital Emergency Care, 23(5), 718–729. https://doi.org/10.1080/10903127.2019.1566421
Agarwal, G., Bhandari, M., Pirrie, M., Angeles, R., & Marzanek, F. (2020). Feasibility of implementing a community cardiovascular health promotion program with paramedics and volunteers in a South Asian population. BMC Public Health, 20(1), 1618. https://doi.org/10.1186/s12889-020-09728-9
Agarwal, G., McDonough, B., Angeles, R., Pirrie, M., Marzanek, F., McLeod, B., & Dolovich, L. (2015). Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors’ housing buildings in Ontario, Canada. BMJ Open, 5(6), e008110. https://doi.org/10.1136/bmjopen-2015-008110
Agarwal, G., Pirrie, M., Angeles, R., Marzanek, F., Paterson, J. M., Nguyen, F., & Thabane, L. (2024). Community paramedicine program in social housing and health service utilization: A cluster randomized clinical trial. JAMA Network Open, 7(10), e2441288. https://doi.org/10.1001/jamanetworkopen.2024.41288
Bigham, B. L., Kennedy, S. M., Drennan, I., & Morrison, L. J. (2013). Expanding paramedic scope of practice in the community: A systematic review of the literature. Prehospital Emergency Care, 17(3), 361–372. https://doi.org/10.3109/10903127.2013.792890
Bourdages, S., Olaf, M., Schoenwetter, D., & Berger, A. (2024). Mobile integrated health and hospital utilization for congestive heart failure in a rural setting. Prehospital Emergency Care, 28(1), 186–191. https://doi.org/10.1080/10903127.2023.2217259
Burnett, A., Wewerka, S., Miller, P., Majerus, A., Clark, J., Crippes, L., & Radant, T. (2023). Community paramedicine intervention reduces hospital readmission and emergency department utilization for patients with cardiopulmonary conditions. Western Journal of Emergency Medicine, 24(4). https://doi.org/10.5811/WESTJEM.57862
Choi, B. Y., Blumberg, C., & Williams, K. (2016). Mobile integrated health care and community paramedicine: An emerging emergency medical services concept. Annals of Emergency Medicine, 67(3), 361–366. https://doi.org/10.1016/j.annemergmed.2015.06.005
Dharmarajan, K., Hsieh, A. F., Lin, Z., Bueno, H., Ross, J. S., Horwitz, L. I., Barreto-Filho, J. A., Kim, N., Bernheim, S. M., Suter, L. G., Drye, E. E., & Krumholz, H. M. (2013). Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA, 309(4), 355. https://doi.org/10.1001/jama.2012.216476
Dharmarajan, K., Wang, Y., Lin, Z., Normand, S.-L. T., Ross, J. S., Horwitz, L. I., Desai, N. R., Suter, L. G., Drye, E. E., Bernheim, S. M., & Krumholz, H. M. (2017). Association of changing hospital readmission rates with mortality rates after hospital discharge. JAMA, 318(3), 270–278. https://doi.org/10.1001/jama.2017.8444
Feldman, B. A., Rivera, O. E., Greb, C. J., Jacoby, J. L., Nesfeder, J., Secheresiu, P., Shah, M., & Sundlof, D. W. (2022). “House Calls” by mobile integrated health paramedics for patients with heart failure: A feasibility study. Prehospital Emergency Care, 26(6), 747–755. https://doi.org/10.1080/10903127.2021.1977439
Gingold, D. B., Liang, Y., Stryckman, B., & Marcozzi, D. (2021). The effect of a mobile integrated health program on health care cost and utilization. Health Services Research, 56(6), 1146–1155. https://doi.org/10.1111/1475-6773.13773
Gregg, A., Tutek, J., Leatherwood, M. D., Crawford, W., Friend, R., Crowther, M., & McKinney, R. (2019). Systematic review of community paramedicine and EMS mobile integrated health care interventions in the United States. Population Health Management, 22(3), 213–222. https://doi.org/10.1089/pop.2018.0114
Harring, A. K. V., Kjærgaard, M., & Gehrt, T. B. (2025). Frequent callers vs. frequent users – A scoping review of frequent contacts to the emergency medical services. International Journal of Emergency Medicine, 18(1), 108. https://doi.org/10.1186/s12245-025-00925-0
Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwood, D. W., Rosal, M., & Yancy, C. W. (2015). Social determinants of risk and outcomes for cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 132(9), 873–898. https://doi.org/10.1161/CIR.0000000000000228
Johnston, K. J., Wen, H., & Joynt Maddox, K. E. (2019). Lack of access to specialists associated with mortality and preventable hospitalizations of rural medicare beneficiaries. Health Affairs, 38(12), 1993–2002. https://doi.org/10.1377/hlthaff.2019.00838
Lurie, T., Adibhatla, S., Betz, G., Palmer, J., Raffman, A., Andhavarapu, S., Harris, A., Tran, Q. K., & Gingold, D. B. (2023). Mobile integrated health-community paramedicine programs’ effect on emergency department visits: An exploratory meta-analysis. The American Journal of Emergency Medicine, 66, 1–10. https://doi.org/10.1016/j.ajem.2022.12.041
O’Meara, P., Stirling, C., Ruest, M., & Martin, A. (2015). Community paramedicine model of care: An observational, ethnographic case study. BMC Health Services Research, 16(1), 39. https://doi.org/10.1186/s12913-016-1282-0
Palaniappan, L. P., Allen, N. B., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Bansal, N., Currie, M. E., Earlie, R. S., Fan, W., Fetterman, J. L., Barone Gibbs, B., Heard, D. G., Hiremath, S., Hong, H., Hyacinth, H. I., Ibeh, C., Jiang, T., … on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Committee. (2026). 2026 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation, 153(9). https://doi.org/10.1161/CIR.0000000000001412
Rasku, T., Kaunonen, M., Thyer, E., Paavilainen, E., & Joronen, K. (2019). The core components of Community Paramedicine – integrated care in primary care setting: A scoping review. Scandinavian Journal of Caring Sciences, 33(3), 508–521. https://doi.org/10.1111/scs.12659
Savarese, G., Division of Cardiology, Department of Medicine, Karolinska Insitutet, Stockholm, Sweden, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden, Lund, L. H., Division of Cardiology, Department of Medicine, Karolinska Insitutet, Stockholm, Sweden, & Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. (2017). Global Public Health Burden of Heart Failure. Cardiac Failure Review, 03(01), 7. https://doi.org/10.15420/cfr.2016:25:2
Sokan, O., Stryckman, B., Liang, Y., Osotimehin, S., Gingold, D. B., Blakeslee, W. W., Moore, M. J., Banas, C. A., Landi, C. T., & Rodriguez, M. (2022). Impact of a mobile integrated healthcare and community paramedicine program on improving medication adherence in patients with heart failure and chronic obstructive pulmonary disease after hospital discharge: A pilot study. Exploratory Research in Clinical and Social Pharmacy, 8, 100201. https://doi.org/10.1016/j.rcsop.2022.100201
Ulintz, A. J., O’Connor, L. C., Heffern, T. M., Rowe, J., Rollman, J. E., Wingrove, G., Zavadsky, M., Wilcox, M. R., & Goldberg, S. A. (2025). Mobile integrated health care and community paramedicine: A position statement and resource document of NAEMSP. Prehospital Emergency Care, 1–13. https://doi.org/10.1080/10903127.2025.2541899
Van Spall, H. G. C., Rahman, T., Mytton, O., Ramasundarahettige, C., Ibrahim, Q., Kabali, C., Coppens, M., Brian Haynes, R., & Connolly, S. (2017). Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: A systematic review and network meta-analysis. European Journal of Heart Failure, 19(11), 1427–1443. https://doi.org/10.1002/ejhf.765
Wilder, M. E., Kulie, P., Jensen, C., Levett, P., Blanchard, J., Dominguez, L. W., Portela, M., Srivastava, A., Li, Y., & McCarthy, M. L. (2021). The impact of social determinants of health on medication adherence: A systematic review and meta-analysis. Journal of General Internal Medicine, 36(5), 1359–1370. https://doi.org/10.1007/s11606-020-06447-0