EJCPR: Telehealth models improve prognosis for cardiac patients
The use of phone and internet between patients and providers is an effective way to reduce risk factors for coronary heart disease as well as the risk of further events after an MI, according to new research published in the June issue of the European Journal of Cardiovascular Prevention & Rehabilitation.

The study's senior author Ben Freedman, ND, from the department of cardiology at the Concord Repatriation General Hospital in Sydney, Australia, said 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."

Previous evidence has shown that formal cardiac rehabilitation programs consistently reduce the risk of further events, improve personal risk factor profiles, encourage compliance with drug therapy and enhance quality of life through exercise and education, the authors said. However, according to Freedman, it is also known that only one-third of eligible patients participate in cardiac rehabilitation programs in Europe, the U.S. and Australia.

The new study, a systematic review of trials applying new communication technologies in cardiac prevention, suggested that telehealth can provide an "innovative model" by which access is increased and the "diverse nature of people and communities accommodated". The review analyzed all published randomized 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.

In total, 11 trials were identified involving 3,145 patients. Telehealth interventions were associated with nonsignificant lower all-cause mortality than controls [relative risk, 0.70]. These interventions showed a significantly lower weighted mean difference (WMD) at medium long-term follow up than controls for total cholesterol (WMD, 0.37 mmol/l), systolic blood pressure (WMD, 4.69 mmHg) and fewer smokers (relative risk, 0.84).

Significant favorable changes at follow-up were also found in high-density lipoprotien and low-density lipoprotein, according to the researchers.

"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...suggests that the electronic age is indeed providing effective alternatives for the delivery of preventive health change," said the study's co-author, Lis Neubeck, MD, from Concord Repatriation General Hospital in Sydney, Australia.

The study defined telehealth prevention programs as those which made at least 50 percent 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. The authors noted that only two of the 11 trials used an internet program, which included progress graphs, online rewards and discussion groups with experts and other patients. No trials using other communication technologies--such as video conferencing--were found.

Results of the analysis showed that the telehealth interventions were associated with a 30 percent lower mortality rate than non-intervention controls, but this was not statistically significant and reflected a real-life "absolute" risk reduction of 1 percent. 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. Favorable effects were also found in levels of physical activity and quality of life.

"People today are increasingly time-poor," Neubeck said, "and attendance at a center-based program for the secondary prevention of recurrent coronary events tends to limit access. Utilizing electronic technologies has the potential to increase access for these services without compromising outcomes.

"It's worth noting that three of the programs we reviewed were from Australia," the authors wrote. "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."