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 Wednesday 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, said telehealth models could help patients who lack access to cardiac rehabilitation services increase coronary prevention activities and “narrow the gap between evidence and practice.”

The evidence has already shown that formal cardiac rehabilitation programs 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 education.

However, Freedman said, it is also known that only one-third of eligible patients participate in cardiac rehabilitation programs in Europe, the United States 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 accommodated,” he said.

Telehealth helped reduce risk factors

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.

“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,” said, Lis Neubeck from Concord Repatriation General Hospital in Sydney and the study’s lead author. “Our analysis, which involved more than 3,000 patients across 11 studies, suggests that the electronic age is indeed providing effective alternatives for the delivery of preventive health change.”
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 per cent.

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," said Neubeck, "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."