Online Treatment May Benefit Patients with Heart Disease

Patients with heart disease may benefit from an internet-based treatment program, suggest results of a study published in the BMJ.

The study found that an internet-based, nurse-led treatment program on top of usual care effectively reduced vascular risk factors in patients with vascular disease.

“The intervention used in this study is easy to implement in clinical practice at low cost and could be used for various groups of patients at high cardiovascular risk,” note the investigators.

Treatment of vascular risk factors by nurse practitioners has been shown to be effective in reducing cardiovascular risk factors and vascular risk, but this treatment is costly and time consuming for patients and healthcare professionals, as frequent visits to the outpatient clinic are needed.

Use of the internet is a low-cost method compared with a regular outpatient clinic. The researchers therefore conducted a randomized controlled trial to assess whether including an internet-based program would be effective in reducing vascular risk factors in patients with the disease.

A total of 330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal were included in the study. They were randomly assigned to receive either internet-based or usual care for 12 months.

The internet-based program included a personalized website with an overview and actual status of patients’ risk factors. It also involved mail communication via the website with a nurse practitioner, self-management support, monitoring of disease control, and drug treatment.

The researchers, from the University Medical Center Utrecht in The Netherlands, found that the Framingham heart risk score had fallen 12% further among patients in the intervention group compared with the usual care group after one year.

The intervention group also had a 3 mmol/l greater decrease in low-density lipoprotein cholesterol than the usual care group, and had more patients stop smoking (8 vs 4).

Other risk factors, such as body mass index, triglycerides, systolic blood pressure, and renal function, tended to improve in the intervention versus usual care group, but did not reach statistical significance.

Frank Visseren and team conclude that an internet-based, nurse-led vascular prevention program, on top of usual care, may help reduce long-term risk for vascular events or death. They stress that the clinical importance of this is “small and limited,” but say that the intervention would be easy to implement into clinical practice and might be useful for various groups of patients at high cardiovascular risk.

By Nikki Withers