BMJ: Internet-based, nurse led treatment program has little effect on reducing vascular risk

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Research published June 12 in  BMJ found that an internet-based, nurse led treatment program in addition to usual care for vascular risk factors had a small effect on lowering some vascular risk factors in patients with the disease.

J.W.P. Vernooij, PhD candidate, from the department of vascular medicine at the University Medical Center Utrecht in the Netherlands, and colleagues, conducted a prospective randomized controlled trial to investigate whether such a program is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease.

The researchers enrolled 330 patients with a recent manifestation of atherosclerosis in the coronary, cerebral or peripheral arteries in the study. Using the relative change in Framingham Risk Score after one year as the primary endpoint, a personalized website with an overview and actual status of patients’ risk factors and mail communication via the website with a nurse practitioner for 12 months was used as an intervention. The intervention combined self-management support, monitoring of disease control and drug treatment.

Participants’ mean age was 59.9 years, and 75 percent were male. After one year, the relative change in Framingham score of the intervention group compared with the usual care group decreased 14 points.

“At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score,” the authors wrote. “This produced a relative change of -12 percent in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8 percent adjusted for the baseline score.”

Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7 percent, -14.9 percent to -0.4 percent). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria).

Of the 155 patients in the intervention group, 152 patients actually logged in, the authors noted, adding they logged in a median of 56 times during the year. Overall, 134 patients sent a median 14 messages and 131 patients entered a median of seven measurements during the year. “Measurements most often entered related to blood pressure (111 patients, median two) and weight (114 patients, median three),” they wrote. “The monthly number of logins decreased during the intervention period, from a maximum in the third month with 1,099 logins to 435 logins in the 12th month.”

The authors concluded that the intervention used in the study is "easy to implement in clinical practice at low cost and could be used for various groups of patients at high cardiovascular risk."