Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management–Related Outcomes

Abstract

Introduction:Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access.Objective:The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness.Method:Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase).Results:Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used.Conclusion:More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

“…100 A systematic review on internet-delivered interventions in patients with CAD has shown that personalised, concrete support for behaviour change may have favourable outcomes; however, a considerable heterogeneity between studies with respect to the design and quality hinder sound conclusions. 101 Adherence Cardiovascular fixed-dose combination pills, or polypills, may help address the widespread lack of access and adherence to proved medicines. Adherence benefits from switching to a polypill resulted in risk factor changes that were at least as good as usual care across a wide variety of treatment patterns, including equally potent or more potent regimens.…”

A pilot-study to assess the feasibility and acceptability of an Internet-based cognitive-behavior group therapy using video conference for patients with coronary artery heart disease

“…Review studies on the effectiveness of Internet-based interventions have indicated that users are satisfied and that they result in improved behaviors and clinical outcomes compared with nonusers for patients with CAD [14,15,16,17].…”

Educational program for coronary artery disease patients: results after one year

“…Even though the frequency and duration of the intervention could not be established, the authors concluded that telecommunication health education models can assist in secondary prevention of CAD and narrow the gap between evidence of the benefits of rehabilitation programs and the difficulty of implementation in clinical practice (20) . In another systematic review of internet interventions for promoting CAD self-management, the authors concluded there is a need for more robust and well-delineated clinical trials (21) . These studies should explore how interventions work and how to improve participants' adherence to rehabilitation programs (21) .…”

“…In another systematic review of internet interventions for promoting CAD self-management, the authors concluded there is a need for more robust and well-delineated clinical trials (21) . These studies should explore how interventions work and how to improve participants' adherence to rehabilitation programs (21) . In 2016, the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) released strategies for implementing cardiac rehabilitation programs in developing countries (22) .…”