New communication technologies help cardiac patients improve their
29 June 2009
The use of 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 new research published in the June issue of the European Journal
of Cardiovascular Prevention & Rehabilitation .
The study’s senior investigator, Professor Ben Freedman from the
Department of Cardiology at Concord Repatriation General Hospital,
Sydney, Australia, says that the provision of “telehealth” models could
help increase the uptake of coronary prevention activities by those
without access to cardiac rehabilitation, and “narrow the gap between
evidence and practice”.
That evidence has already shown that formal cardiac rehabilitation
programmes consistently reduce the risk of further events (secondary
prevention), improve personal risk factor profiles, encourage compliance
with drug therapy, and enhance quality of life through exercise and
However, according to Professor Freedman, it is also known that only
one-third of eligible patients participate in cardiac rehabilitation
programmes in Europe, the USA and Australia.
This new study, a systematic review of trials applying new
communication technologies in cardiac prevention, suggests that
telehealth can indeed provide an “innovative model” by which access is
increased and the “diverse nature of people and communities
The review analysed all published randomised trials evaluating a
telephone or internet-based intervention whose end-points were a measure
of mortality, changes in levels of multiple risk factors for heart
disease, or quality of life.
Lead author, Lis Neubeck from Concord Repatriation General Hospital
in Sydney, said: “We 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 3000 patients across 11 studies,
suggests that the electronic age is indeed providing effective
alternatives for the delivery of preventive health change.”
The study defined telehealth prevention programmes as those which
made at least 50% of their patient contact through telephone or
internet. However, total patient contact in the studies assessed varied
in length — from just 40 minutes to nine hours. In more than half the
studies a nurse delivered the intervention. The most common methods of
contact were by telephone, and around half the trials supplemented new
technology communication with written information.
Only two of the 11 trials used an internet programme, which included
progress graphs, online rewards and discussion groups with experts and
other patients. No trials using other communication technologies — such
as videoconferencing — were found.
Results of the analysis showed that the telehealth interventions were
associated with a 30% lower mortality rate than non-intervention
controls, but this was not statistically significant and reflected a
real-life “absolute” risk reduction of 1%. However, there were
significant findings in the effect of telehealth on modifiable risk
factors for coronary disease.
Follow-up showed lower total cholesterol levels in the telehealth
patients than in controls, lower levels of systolic blood pressure, and
fewer people continuing to smoke. Favourable effects were also found in
levels of physical activity and quality of life.
“People today are increasingly time-poor,” says Lis Neubeck, “and
attendance at a centre-based programme for the secondary prevention of
recurrent coronary events tends to limit access. Utilising electronic
technologies has the potential to increase access for these services
without compromising outcomes.
“It’s worth noting that three of the programmes we reviewed were from
Australia. The CHOICE study, for example, showed that a brief flexible
intervention provides effective risk factor reduction for 12 months
following an acute heart event. Reaching people in rural and remote
communities is a particular problem in Australia and these interventions
have the potential to overcome barriers of time and distance, thus
enabling us to reach populations with problems in accessing healthcare,
at affordable cost.”
1. Full bibliographic information Neubeck L, Redfern J, Fernandez R,
Briffa T, Bauman A, Freedman SB. Telehealth interventions for the
secondary prevention of coronary heart disease: a systematic review.
Eur J Cardiovasc Prev Rehabil 2009; 16; 281-289.
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