Telehealth interventions for primary prevention of cardiovascular disease: A systematic review and meta-analysis

Merriel, Samuel W D; Andrews, Verity; Salisbury, Chris

doi:10.1016/j.ypmed.2014.04.001

Cited by 41 publications

(39 citation statements)

References 42 publications

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“…Compared with pharmacological treatments for acute events and with secondary prevention, reductions in the prevalence of CVD risk factors have resulted in greater reductions in CVD-related mortality. 254 However, the amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets. 255 mHealth or mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.…”

Section: How Mhealth Tools Can Improve Healthcare Delivery When Partnmentioning

confidence: 99%

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

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

477

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: How Mhealth Tools Can Improve Healthcare Delivery When Partnmentioning

confidence: 99%

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

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

477

389

View full text Add to dashboard Cite

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“…We supplemented the meta-review with a review of depression, as well as a new systematic review to look in more detail at studies of telehealth interventions focused on those for the prevention of CVD. 61 In addition, we identified and reviewed published qualitative studies of patients' experiences of using telehealth interventions. In total, we included 16 systematic reviews (representing 662 quantitative studies) and 29 qualitative studies.…”

Section: Evidence Reviewmentioning

confidence: 99%

“…Of the four studies that reported an outcome of overall CVD risk, one showed a small reduction in overall risk associated with the intervention, 48 but this was not found in the other studies or a meta-analysis. 61 A more recent study from the Netherlands reported the findings of an online nurse practitioner-supported intervention for vascular risk management in patients with clinically manifest vascular disease. 376 Although…”

Section: Relationship To Previous Researchmentioning

confidence: 99%

“…81 With regards to participants at raised CVD risk, earlier research had demonstrated the effectiveness of telehealth interventions for specific risk factors such as hypertension 150 and smoking cessation, 385,386 but our systematic review of trials of telehealth interventions aimed at reducing multiple risk factors to reduce overall CVD risk found no evidence of effectiveness. 61 Earlier studies of primary prevention interventions to reduce CVD risk based on face-to-face nurse-led care had demonstrated small benefits 410,411 and modelling conducted in advance of the NHS Health Checks programme has suggested that they could be cost-effective in the long term. 34 This conclusion, of limited short-term benefits but with the potential for long-term gains in cost-effectiveness, is consistent with the findings of the Healthlines CVD risk trial.…”

Section: Depression and Cardiovascular Disease Risk As Exemplar Long-mentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…12,13 While TH holds great promise for improving access and delivery of care, there has been a call for further investigation into whether TH delivers similar outcomes as traditional face-to-face (FTF) encounters (ie, usual care) at either the same or lower costs.…”

mentioning

confidence: 99%

Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

Liu

Saxon

McNair

et al. 2016

J Diabetes Sci Technol

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Background: Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. Methods: This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. Results: A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) ( P < .0001) for the TH group and from 9.56% (9.16% to 9.95%) to 8.62% (8.22% to 9.01%) ( P < .0001) for the FTF group after 1 visit. This change in HbA1c was not significantly different in the TH and FTF groups ( P = .24). TH visits were associated with a hypothetical savings in median distance traveled of 231.2 miles per trip (which equates to $94.79 saved per trip). Conclusions: Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes.

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Telehealth interventions for primary prevention of cardiovascular disease: A systematic review and meta-analysis

Cited by 41 publications

References 42 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

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

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