Online nurse support improves vascular disease risk factors

A personalized website and the support of nurse practitioners helped improve some risk factors in patients with vascular disease, according to a study published this week in the British Medical Journal.

Researchers from the University Medical Center Utrecht in The Netherlands developed a 12-month study involving 330 participants. They were divided in two groups: those who used the website and nurse support, and those who received usual care.

Interventions included the website, which included email communication with a nurse practitioner, self-management support, monitoring of disease control and pharmacotherapy.

In a one-hour training session, patients were advised to log in at least once every two weeks to submit new data for factors such as blood pressure, weight, smoking status, and cholesterol.

Nurse practitioners communicated with the patients by email, according to a heartwire article, replied to all messages and contacted those not using the program by email or phone when they did not respond. On average, patients used the Internet program 56 times in the year.

The results after one year were measured using Framingham heart risk scores, which predict 10-year risk for coronary heart disease. They were not an ideal tool in this case because they were developed for patients free of vascular disease.

In the end, scores improved 12 percent for the group using the website, and 8 percent for those undergoing usual care, a "small effect," according to the researchers. Still, they said, the intervention is "easy to implement at low cost and could be used for various groups of patients at high CV risk."

"Patients come to the outpatient clinic several times a year, but this is very inefficient from a doctor and patient perspective. For cardiovascular risk-factor management, it is important to support self-management, to deliver care at home," senior author Dr. F.L.J. Visseren told heartwire. "Patients need to work on this--taking their medications and making lifestyle changes--every day, not just for 15 minutes in the clinic. This is an easy web application developed at our hospital. You do not need to be an Internet wizard to employ it."

Several previous studies have supported the use of telemonitoring for patients with conditions including heart failure and hypertension. A study by researchers from the Mayo Clinic and Purdue University, however, found telemonitoring failed to keep elderly at-risk patients out of the hospital.

To learn more:
- here's the study
- check out the heartwire article (registration required)

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