Internet-based Interventions Help Reduce Coronary Heart Disease Risk

June 30, 2009

According to a recent study, the communication via phone and Internet between patients and healthcare providers is “an effective way to reduce risk factors for coronary heart disease and the risk of further events after a heart attack.”

According to a recent study, the communication via phone and Internet between patients and healthcare providers is “an effective way to reduce risk factors for coronary heart disease and the risk of further events after a heart attack.”

A European Society of Cardiology (ESC) press release quotes the study’s senior investigator, Ben Freedman, ND, from the Department of Cardiology at Concord Repatriation General Hospital, Sydney, Australia, who said that more widespread implementation of telehealth interventions in cardiology could “help increase the uptake of coronary prevention activities by those without access to cardiac rehabilitation, and narrow the gap between evidence and practice.”

The study, titled “Telehealth Interventions for the Secondary Prevention of Coronary Heart Disease: A Systematic Review,” was a systematic review and meta-analysis of randomized controlled clinical trials evaluating telehealth interventions (defined for the purposes of the study as “phone, Internet, and videoconference communication between patient and health-care provider”) in patients with coronary heart disease. The authors searched a variety of online and electronic databases, the published clinical literature, and other sources, and identified 11 clinical trials that “evaluated a telephone, videoconference, or Web-based intervention; [and] provided objective measurements of mortality changes in multiple risk factor levels or quality of life.”

The authors reported that “telehealth interventions were associated with non-significant lower all-cause mortality than controls.” Subjects who participated in a telehealth intervention experienced more favorable outcomes in terms of total cholesterol, systolic blood pressure, high-density lipoprotein, and low-density lipoprotein. Based on this analysis, the authors concluded that “telehealth interventions provide effective risk factor reduction and secondary prevention. Provision of telehealth models could help increase uptake of a formal secondary prevention by those who do not access cardiac rehabilitation and narrow the current evidence-practice gap.”

In the ESC press release, the study’s lead author, Lis Neubeck, MD, said that the study “aimed to determine if, in a world increasingly dominated by electronic technology, interventions for preventing recurrent coronary disease could be delivered in innovative ways to enable more people to access effective secondary prevention. Our analysis, which involved more than 3,000 patients across 11 studies, suggests that the electronic age is indeed providing effective alternatives for the delivery of preventive health change.”

This news comes with several caveats, however. Although, the telehealth interventions studied for this analysis had to make “at least 50% of their patient contact through telephone or Internet,” total patient contact time in the studies assessed varied (just 40 minutes in some, to up to nine hours in others). The ECG press release also notes that “in more than half the studies a nurse delivered the intervention,” telephone calls were the most common methods of interacting with patients, and many of the trials also employed a significant amount of supplemental written information. Only two of the 11 trials included an Internet component.