Healthy ageing through internet counselling in the elderly (HATICE): a multinational, randomised controlled trial

Abstract

Background Although web-based interventions have been promoted for cardiovascular risk management over the past decade, there is limited evidence for effectiveness of these interventions in people older than 65 years. The healthy ageing through internet counselling in the elderly (HATICE) trial aimed to determine whether a coach-supported internet intervention for self-management can reduce cardiovascular risk in community-dwelling older people.Methods This prospective open-label, blinded endpoint clinical trial among people age 65 years or over at increased risk of cardiovascular disease randomly assigned participants in the Netherlands, Finland, and France to an interactive internet intervention stimulating coach-supported self-management or a control platform. Primary outcome was the difference from baseline to 18 months on a standardised composite score (Z score) of systolic blood pressure, LDL cholesterol, and body-mass index (BMI). Secondary outcomes included individual risk factors and cardiovascular endpoints. This trial is registered with the ISRCTN registry, 48151589, and is closed to accrual.Findings Among 2724 participants, complete primary outcome data were available for 2398 (88%). After 18 months, the primary outcome improved in the intervention group versus the control group (0·09 vs 0·04, respectively; mean difference -0·05, 95% CI -0·08 to -0·01; p=0·008). For individual components of the primary outcome, mean differences (intervention vs control) were systolic blood pressure -1·79 mm Hg versus -0·67 mm Hg (-1·12, -2·51 to 0·27); BMI -0·23 kg/m² versus -0·08 kg/m² (-0·15, -0·28 to -0·01); and LDL -0·12 mmol/L versus -0·07 mmol/L (-0·05, -0·11 to 0·01). Cardiovascular disease occurred in 30 (2·2%) of 1382 patients in the intervention versus 32 (2·4%) of 1333 patients in the control group (hazard ratio 0·86, 95% CI 0·52 to 1·43).Interpretation Coach-supported self-management of cardiovascular risk factors using an interactive internet intervention is feasible in an older population, and leads to a modest improvement of cardiovascular risk profile. When implemented on a large scale this could potentially reduce the burden of cardiovascular disease.Funding European Commission Seventh Framework Programme.

Characteristics and Symptoms of App Users Seeking COVID-19–Related Digital Health Information and Remote Services: Retrospective Cohort Study

“…The current low level of adoption of digital health by older adults is unfortunate, as digital health technologies have the potential to improve communication and collaboration and promote healthy and independent ageing. Indeed, recent research suggests that digital solutions tailored for older adults improve health management [ 30 ]. Barriers to the adoption of digital health by older adults include visual impairment, limitations in dexterity, and lack of self-confidence when using technology.…”

Experiences of dementia and attitude towards prevention: a qualitative study among older adults participating in a prevention trial

“…ACCEPT-HATICE study has been described in detail previously [14]. Briefly, both quantitative and qualitative approaches (questionnaires and interviews) were used to explore participants' reasons for enrolling in HATICE, an 18-month eHealth RCT in Finland, France, and the Netherlands investigating the efficacy of a lifestyle intervention, delivered through an Internet platform, in supporting CVRF self-management and preventing CVD and cognitive decline [15,16]. In HATICE, 2724 cognitively healthy community dwellers aged 65+, with at least two CVRFs and/or diagnosed CVD or diabetes, were randomised 1:1 to the intervention or control group.…”

“…Because of this, the topic could not be investigated starting from a more general conceptual framework and including data from all three countries involved in HATICE, like in the main ACCEPT-HATICE study. Different HATICE recruitment strategies in each country and differences in culture and healthcare settings [14,16] may explain why the topic of cognitive disorders was raised only by the Finnish interviewees. Conducting this substudy in all three countries could have potentially strengthened our results and improved their applicability in other geographical, cultural, or healthcare settings.…”

“…ACCEPT-HATICE [14] is a sub-study of the "Healthy Ageing Through Internet Counselling in the Elderly" (HATICE) RCT (ISRCTN48151589) which aimed at testing the efficacy of a novel eHealth tool in improving selfmanagement of cardiovascular risk factors (CVRF) and preventing cardiovascular disease (CVD) and cognitive decline [15,16]. Based on the ACCEPT study [17], ACCEPT-HATICE was one of the first studies to investigate at-risk older adults' reasons for participating in a large, longer-term multidomain lifestyle prevention trial, using both quantitative and qualitative methods.…”

How can population‐based studies best be utilized to reduce the global impact of dementia? Recommendations for researchers, funders, and policymakers

“…Other similar studies such as the Prevention of Dementia by Intensive Vascular Care (preDIVA) and the Multidomain Alzheimer Preventive Trial (MAPT) trials, which combined cognitive, lifestyle (diet, physical activity, smoking cessation), and pharmacological interventions, observed protective effects in individuals with elevated vascular or dementia risk 28,29 . The Healthy Aging Through Internet Counseling in the Elderly (HATICE) trial found that older people can reduce their risk of cardiovascular disease and dementia by improving their lifestyle and adopting healthier behaviors with the support of an online coach 30 …”