Therapeutic Benefit of Internet-Based Lifestyle Counselling for Hypertension

Nolan, Robert P.; Liu, Sam; Shoemaker, J. Kevin; Hachinski, Vladimir; Lynn, Hazel; Mikulis, David J.; Wennberg, Richard; Lum-Kwong, Margaret Moy; Zbib, Ahmad

doi:10.1016/j.cjca.2012.02.012

Cited by 46 publications

(53 citation statements)

References 29 publications

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“…Madsen et al 191 augmented the e-mail information exchange with messages sent via a PDA. Cicolini et al 202 and Nolan et al, 195 using a completers' analysis, reported a significant difference between groups in BP changes, whereas Madsen et al, 191 using intention-to-treat analysis, did not find a difference in BP between groups but observed that a significantly higher proportion of the intervention group achieved the target BP.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 92%

“…191,195,202 These studies ranged from 4 to 6 months, and all had high retention. The frequency of the e-mail contact was not specified in the Nolan et al 195 study and was frequent in the other studies. Madsen et al 191 augmented the e-mail information exchange with messages sent via a PDA.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

“…Additionally, Liu et al also found trends of greater effects when interventions used multiple behavioral techniques and were proactive with patients (as opposed to reactive or passive). Nolan et al 195 conducted the 1 study to specifically explicate a theoretical framework.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

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

475

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: 92%

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

See 1 more Smart Citation

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

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

475

389

View full text Add to dashboard Cite

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“…Three of the trials demonstrated a small but significant reduction in total cholesterol when the telehealth intervention groups were compared with control groups. 48,179,183 Overall, random-effects modelling showed that these telehealth interventions reduced total cholesterol by 0.07 mmol/l (95% CI -0.19 to 0.06). Figure 5 gives the full meta-analysis results.…”

Section: Study or Subgroupmentioning

confidence: 99%

“…Four studies found a significantly larger reduction in systolic blood pressure in the intervention groups when compared to the control groups. 179,[181][182][183] The trial by Dekkers et al 179 featured two telehealth treatment arms, one delivered via telephone and the other via the internet. Summarising all included studies using a random-effects model suggests that multi-focal telehealth interventions have a small effect on reducing systolic blood pressure (SMD -1.22 mmHg, 95% CI -2.80 to 0.35 mmHg).…”

Section: Impact On Modifiable Cvd Risk Factorsmentioning

confidence: 99%

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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Internet-based interventions for the secondary prevention of coronary heart disease

Devi

Singh

Powell

et al. 2015

Cochrane Database of Systematic Reviews

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Background The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease (CHD). Objectives To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, in December 2014. We also searched six other databases in October 2014, and three trials registers in January 2015 together with reference checking and handsearching to identify additional studies. Selection criteria Randomised controlled trials (RCTs) evaluating Internet-delivered secondary prevention interventions aimed at people with CHD. Data collection and analysis Two review authors independently assessed risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed evidence quality using the GRADE approach and presented this in a 'Summary of findings' table. Main results Eighteen trials met our inclusion criteria. Eleven studies are complete (1392 participants), and seven are ongoing. Of the completed studies, seven interventions are broad, targeting the lifestyle management of CHD, and four focused on physical activity promotion. The comparison group in trials was usual care (n = 6), minimal intervention (n = 3), or traditional cardiac rehabilitation (n = 2). Internet-based interventions for the secondary prevention of coronary heart disease (Review)

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Therapeutic Benefit of Internet-Based Lifestyle Counselling for Hypertension

Cited by 46 publications

References 29 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

Internet-based interventions for the secondary prevention of coronary heart disease

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