Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia

Abstract

This pilot randomized controlled trial (RCT) aimed to determine the acceptability and preliminary efficacy of a web-based cardiovascular disease (CVD) prevention intervention for women following preeclampsia. Australian women with a recent history (≤4 years post diagnosis) of preeclampsia were randomized into two study arms: (1) Be Healthe for your Heart, a web-based behavioral intervention or; (2) Control, access to the National Heart Foundation website. Assessments were conducted at baseline, and after three months. Intervention acceptability and impact on absolute CVD 30-year risk score, CVD risk markers and health behaviors were assessed. Twenty-four of 31 (77.4%) women completed the three-month assessment. Eleven out of 13 intervention participants (84.6%) agreed/strongly agreed they were satisfied with the program, with a mean score of 4.2 ± 0.9 (maximum of five). There were no significant between or within group differences in absolute CVD risk, CVD risk markers or health behaviors from baseline to three months. Women with a history of preeclampsia were successfully recruited and retained and they reported high levels of acceptability with the Be Healthe for your Heart program. Further research is therefore needed from powered trials to determine the impact of web-based lifestyle interventions on CVD risk in this at-risk group.

Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

“…Occurrence, n (%) References Themes/observations 12 (9.1) [27,30,35,37,38,40,41,45,46,49,57,58] Increased self-management 11 (8.3) [23,25,31,33,41,43,47,51,52,61,62] Pandemic created acceptance of technology 10 (7.6) [32,34,35,37,38,40,43,46,58,67] Increased adherence 9 (6.8) [24,[27][28][29][30]41,52,53,60] Increased access 8 (6.1) [49,50,54,55,[62][63][64]66] Increased social support 7 (5.3) ...…”

“…The remaining five observations made up a total of 6% of the total occurrences: decrease in quality of life after intervention, discomfort for wearing monitors, workflow issues for providers, lack of data infrastructure, and interoperability. [23,25,26,[28][29][30][31]35,37,[41][42][43][44]49,57,60,62,65,66] Technical literacy 12 ( 14) [26,27,29,30,[36][37][38][39]45,49,57,62] Technology needs further development 8 ( 9) [22,28,35,41,43,51,60,62] Availability of technology 7 (8) [38,39,41,43,44,46,59] Cost 7 (8) …”

“…Only one article did not report a result as compared to the control group because it was a posttrial analysis and it did not address the control group. [28,32,35,38,40,41,43,46,[48][49][50][53][54][55][58][59][60]64] Telemedicine improved results compared to control 9 ( 14) [27,30,33,34,39,45,51,56,62] No statistically significant difference 7 (11) [24,25,43,47,49,50,63] Improved patient satisfaction 6 (9) [36,49,60,62,64,67] Improved health behaviors 6 (9) [22,38,40,41,49,67] Improved compliance/adherence 5 (8) [28,…”

“…The following individual observations contributed to 30% of the total observations: reduction in blood pressure, reduction in mean tacrolimus trough coefficient of variation, improved annual rate of estimated glomerular filtration rate (eGFR) decline, decrease in medication use, decrease incidence of heart failure, decreased mortality, improved mental health inventory, decreased intracranial hemorrhage, and telemedicine identified other areas for intervention. [27,32,35,40,46,48,[53][54][55]58,59,67] Improved in at least one area 3 (10) [30,33,45] No statistically significant difference 3 (10) [32,35,58] Decreased body weight 2 (7) [27,35] Decreased fat mass 2 (7) [43,67] Improved self-management 2 (7) [43,60] Increase in controlled asthma 2 (7) [55,59] Improved quality of life 1 (3) [40] Reductions in blood pressure 1 (3) [54] Reduction in mean tacrolimus trough coefficient of variation…”

“…Health care administrators can focus on the findings demonstrating that implementation of telemedicine will increase self-management [27,30,35,37,38,40,41,45,46,49,57,58], adherence [32,34,35,37,38,40,43,46,58,67], access [24,27-30, 41,52,53,60], and social support [49,50,54,55,[62][63][64]66]. Telemedicine is shown to be an effective modality of treatment [28,32,35,38,40,41,43,46,[48][49][50][53][54][55][58][59][60]64] at a decreased cost…”