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Published on: January 29, 2013
Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised
J W P Vernooij1, H A H Kaasjager, Y van der Graaf
1Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands.
Insights
An internet-based, nurse-led program modestly reduced vascular risk in patients with established vascular disease. The intervention, promoting self-management alongside usual care, showed a small but significant effect on overall vascular risk scores and specific factors like LDL cholesterol and smoking cessation.
Area of Science:
- Cardiovascular Medicine
- Digital Health
- Health Services Research
Background:
- Patients with clinically manifest vascular disease often have multiple treatable risk factors.
- Effective management of these risk factors is crucial for secondary prevention.
- Existing care models may not fully optimize patient self-management and adherence.
Purpose of the Study:
- To evaluate the efficacy of an internet-based, nurse-led vascular risk factor management program.
- To determine if this program, promoting self-management, improves upon usual care alone.
- To assess the impact on vascular risk factors in patients with established atherosclerotic disease.
Main Methods:
- Prospective, multicenter, randomized controlled trial involving 330 patients with manifest atherosclerosis.
- Intervention group received a personalized website with nurse practitioner communication for 12 months, focusing on self-management, monitoring, and medication.
- Control group received usual care alone.
Main Results:
- The intervention group showed a relative reduction in Framingham heart risk score of -14% (adjusted -12%) compared to usual care.
- Significant improvements were observed in low-density lipoprotein cholesterol levels and smoking cessation rates.
- Trends towards improvement were noted for BMI, triglycerides, systolic blood pressure, and renal function, while glucose and albuminuria showed mixed results.
Conclusions:
- An internet-based, nurse-led program can provide a modest benefit in managing vascular risk factors.
- This approach, integrated with usual care, offers a potential strategy for enhancing secondary prevention in vascular disease patients.
- Further research may explore optimizing digital health interventions for cardiovascular risk reduction.
Objective:
To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease.
Design:
Prospective randomised controlled trial.
Setting:
Multicentre trial in secondary and tertiary healthcare setting.
Participants:
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.
Intervention:
Personalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment.
Main Outcome Measures:
The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor.
Results:
Participants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) 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% (-18% to 2%) 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%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria).
Conclusion:
An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease.
Trial Registration:
Clinical trials NCT00785031.
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