Reducing Blood Pressure With Internet-Based Interventions: A Meta-analysis

Liu, Sam; Dunford, Sarah D.; Leung, Yvonne; Brooks, Dina; Thomas, Scott; Eysenbach, Günther; Nolan, Robert P.

doi:10.1016/j.cjca.2013.02.007

Cited by 110 publications

(85 citation statements)

References 35 publications

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“…203,204 Using the same quality assessment tool for systematic reviews and meta-analyses as in the AHA/ACC guideline, both systematic review studies were rated good quality (indicating a study with the least level of bias and results deemed valid). Both reviews focused on a slightly different topic but shared common features.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

“…Both reviews focused on a slightly different topic but shared common features. Uhlig et al 203 focused on SMBP monitoring with or without additional support, and Liu et al 204 focused on Internet-based interventions for BP control. Both reviews suffered from heterogeneity across studies in SMBP equipment used, intervention modality and components, participants, and BP end points, precluding direct comparisons across studies.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

“…190 Uhlig et al also examined 13 trials comparing SMBP with SMBP plus support and found no evidence to support the benefit of SMBP plus support over SMBP alone. Liu et al 204 examined 13 studies that compared Internet-based counseling interventions on BP control in prehypertensive and hypertensive patients, 11 of which were RCTs. They found that e-counseling interventions significantly reduced daytime SBP by 3.8 mm Hg (95% confidence interval, −5.63 to −2.06).…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

“…Essential components of mHealth interventions to promote BP control also largely remain unknown but likely include behavioral techniques similar to those shown in inperson counseling interventions to be effective, including selfmonitoring, goal setting, and problem solving. Evidence 205 suggests that education alone is not effective in changing behavior, and results from Liu et al 204 suggest that multiple techniques are likely to be more effective than fewer techniques. Other unknowns include whether mHealth intervention components should be proactive or reactive, expert driven (protocol driven, prescriptive messaging) or user driven (collaborative protocol with supportive messaging), and whether some specific behavioral theories are more useful than others to guide intervention components.…”

Section: Gaps and Limitationsmentioning

confidence: 99%

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Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

476

389

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A lthough mortality for cardiovascular disease (CVD) has declined for several decades, heart disease and stroke continue to be the leading causes of death, disability, and high healthcare costs. Unhealthy behaviors related to CVD risk (eg, smoking, sedentary lifestyle, and unhealthful eating habits) remain highly prevalent. The high rates of overweight, obesity, and type 2 diabetes mellitus (T2DM); the persistent presence of uncontrolled hypertension; lipid levels not at target; and the ≈18% of adults who continue to smoke cigarettes pose formidable challenges for achieving improved cardiovascular health.1,2 It is apparent that the performance of healthful behaviors related to the management of CVD risk factors has become an increasingly important facet of the prevention and management of CVD. 3In 2010, the American Heart Association (AHA) made a transformative shift in its strategic plan and added the concept of cardiovascular health.2 To operationalize this concept, the AHA targeted 4 health behaviors in the 2020 Strategic Impact Goals: reduction in smoking and weight, healthful eating, and promotion of regular physical activity. Three health indicators also were included: glucose, blood pressure (BP), and cholesterol. On the basis of the AHA Life's Simple 7 metrics for improved cardiovascular health, <1% of adults in the United States follow a healthful eating plan, only 32% have a normal body mass index, and > 30% have not reached the target levels for lipids or BP. National Health and Nutrition Examination Survey (NHANES) data revealed that people who met ≥6 of the cardiovascular health metrics had a significantly better risk profile (hazard ratio for all-cause mortality, 0.49) compared with individuals who had achieved only 1 metric or none.2 The studies reviewed in this statement targeted these behaviors (ie, smoking, physical activity, healthful eating, and maintaining a healthful weight) and cardiovascular health indicators (ie, blood glucose, lipids, BP, body mass index) as the primary outcomes in the clinical trials testing mobile health (mHealth) interventions.eHealth, or digital health, is the use of emerging communication and information technologies, especially the Internet, to improve health and health care 4 (Table 1). mHealth, a subsegment of eHealth, is the use of mobile computing and communication technologies (eg, mobile phones, wearable sensors) for health services and information.4,5 mHealth technology uses techniques and advanced concepts from an array of disciplines, for example, computer science, electrical and

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Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

Section: Gaps and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

476

389

View full text Add to dashboard Cite

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“…Less than 5% of all studies included appeared in more than one systematic review, indicating the breadth and diversity of studies reviewed. The major modes of program delivery were (a) mHealth, text messaging, mobile, and/or smart-phone technologies (n = 21) (5, 7, 14, 19, 23, 35-37, 39, 41, 44, 52, 62, 80, 90, 94, 98, 104, 110, 114, 119); (b) Web-or Internet-based programs (n = 23) (3,8,15,42,49,60,70,72,78,81,82,84,89,96,105,106,108,111,118,124,129,131,135); (c) telehealth and/or telemonitoring (n = 9) (1,21,28,56,65,85,99,100,125); and (d ) social media (n = 3) (22,87,123). One review included studies of mobile and Internet-based technologies to promote physical activity for individuals with type 2 diabetes (31).…”

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confidence: 99%

Using New Technologies to Improve the Prevention and Management of Chronic Conditions in Populations

Oldenburg

Taylor

O’Neil

et al. 2015

Annu. Rev. Public Health

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Lifestyle factors are important in the development of chronic diseases, such as heart disease, respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle behaviors linked to these conditions. The use of mass media and community-wide strategies targeting these behaviors has been extensively evaluated since the 1970s. This review summarizes some examples of interventions and their use of media conducted within the old communications landscape of the 1970s and 1980s and the key lessons learned from their design, implementation, and evaluation. We then consider the potential and evidence base for using contemporary technology applications and platforms-within the new communications landscape-to improve the prevention and management of lifestyle-related chronic diseases in the future. We discuss the implications and adaptation of lessons derived from the ways in which new technologies are being used in commercial and political contexts and their relevance for public health. Finally, we consider some recent examples of applying new technologies to public health issues and consider some of the challenges in this rapidly developing field. COMMUNITY INTERVENTIONS CONDUCTED WITHIN THE OLD COMMUNICATIONS LANDSCAPESeminal epidemiological studies of the 1950s and 1960s (33, 38) demonstrated the influence of lifestyle-related factors in the development of chronic diseases, such as cancers and heart and respiratory diseases. The potential to ameliorate the risk and burden of lifestyle-related chronic disease using lifestyle-based behavior change strategies was soon realized and continues to this day (47). In developed countries, theory-based community interventions targeting lifestyle-related behavior risk factors commenced in the 1970s and have continued to the present day. Community Studies in the 1970sThe North Karelia Project, Finland. In the early 1970s, Finland had one of the highest cardiovascular disease (CVD) mortality rates in the world. The North Karelia Project started in 1972 as a national pilot and demonstration program aimed at reducing population levels of wellestablished CVD risk factors and thus the incidence of CVD (73,103). This comprehensive, community-wide intervention program utilized multiple lifestyle change strategies, including use of the state-of-the-art mass media of that time-that is, radio, television, billboards, newspapers, magazine articles, pamphlets, and other printed materials-combined with environmental and legislative approaches. The project developed and evaluated a model that systematically addressed the steps leading to changes in social norms and community-wide behavior change. After the initial intervention phase (1972)(1973)(1974)(1975)(1976)(1977), the project findings and lessons were further adapted and more widely implemented to develop a comprehensive national heart health program in Finland.An evaluation involving population surveys and disease registers showed that the population risk factor levels in Finland were greatly redu...

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Effectiveness of the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ and an e‐health adjusted care pathway in patients with stable heart failure: results of the ‘e‐Vita HF’ randomized controlled trial

Wagenaar

Broekhuizen

Jaarsma

et al. 2018

European J of Heart Fail

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Background Efficient incorporation of e‐health in patients with heart failure (HF) may enhance health care efficiency and patient empowerment. We aimed to assess the effect on self‐care of (i) the European Society of Cardiology/Heart Failure Association website ‘ heartfailurematters.org ’ on top of usual care, and (ii) an e‐health adjusted care pathway leaving out ‘in person’ routine HF nurse consultations in stable HF patients. Methods and results In a three‐group parallel‐randomized trial in stable HF patients from nine Dutch outpatient clinics, we compared two interventions ( heartfailurematters.org website and an e‐health adjusted care pathway) to usual care. The primary outcome was self‐care measured with the European Heart Failure Self‐care Behaviour Scale. Secondary outcomes were health status, mortality, and hospitalizations. In total, 450 patients were included. The mean age was 66.8 ± 11.0 years, 74.2% were male, and 78.8% classified themselves as New York Heart Association I or II at baseline. After 3 months of follow‐up, the mean score on the self‐care scale was significantly higher in the groups using the website and the adjusted care pathway compared to usual care (73.5 vs. 70.8, 95% confidence interval 0.6–6.2; and 78.2 vs. 70.8, 95% confidence interval 3.8– 9.4, respectively). The effect attenuated, until no differences after 1 year between the groups. Quality of life showed a similar pattern. Other secondary outcomes did not clearly differ between the groups. Conclusions Both the heartfailurematters.org website and an e‐health adjusted care pathway improved self‐care in HF patients on the short term, but not on the long term. Continuous updating of e‐health facilities could be helpful to sustain effects. Clinical Trial registration: ClinicalTrials.gov ID NCT01755988.

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Reducing Blood Pressure With Internet-Based Interventions: A Meta-analysis

Cited by 110 publications

References 35 publications

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Using New Technologies to Improve the Prevention and Management of Chronic Conditions in Populations

Effectiveness of the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ and an e‐health adjusted care pathway in patients with stable heart failure: results of the ‘e‐Vita HF’ randomized controlled trial

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