title: Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial.
abstract: We evaluated whether telehealth counseling augments lifestyle change and risk factor decrease in subjects at high risk for primary or secondary cardiovascular events compared to a recommended guideline for brief preventive counseling. Subjects at high risk or with coronary heart disease (35 to 74 years of age, n = 680) were randomized to active control (risk factor feedback, brief advice, handouts) or telehealth lifestyle counseling (active control plus 6 weekly 1-hour teleconferenced sessions to groups of 4 to 8 subjects). Primary outcome was questionnaire assessment of adherence to daily exercise/physical activity and diet (daily vegetable and fruit intake and restriction of fat and salt) after treatment and at 6-month follow-up. Secondary outcomes were systolic and diastolic blood pressures, ratio of total to high-density lipoprotein cholesterol, and 10-year absolute risk for coronary disease. After treatment and at 6-month follow-up, adherence increased for telehealth versus control in exercise (29.3% and 18.4% vs 2.5% and 9.3%, respectively, odds ratio 1.60, 95% confidence interval 1.2 to 2.1) and diet (37.1% and 38.1% vs 16.7% and 33.3%, respectively, odds ratio 1.41, 95% confidence interval 1.1 to 1.9). Telehealth versus control had greater 6-month decreases in blood pressure (mean ± SE, systolic -4.8 ± 0.8 vs -2.8 ± 0.9 mm Hg, p = 0.04; diastolic -2.7 ± 0.5 vs -1.5 ± 0.6 mm Hg, p = 0.04). Decreases in cholesterol ratio and 10-year absolute risk were significant for the 2 groups. In conclusion, telehealth counseling augments therapeutic lifestyle change in subjects at high risk for cardiovascular events compared to a recommended guideline for brief preventive counseling.
authors.affiliation: University Health Network, Toronto, Ontario, Canada. rnolan@uhnres.utoronto.ca
authors.forename: Robert P
authors.initials: RP
authors.lastname: Nolan
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
authors.forename: Hazel
authors.initials: H
authors.lastname: Lynn
authors.forename: Thomas
authors.initials: T
authors.lastname: Crichton
authors.forename: Ellen
authors.initials: E
authors.lastname: Rukholm
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Caroline
authors.initials: C
authors.lastname: Chessex
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Harvey
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Louise
authors.initials: L
authors.lastname: Picard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Michel
authors.forename: Jan
authors.initials: J
authors.lastname: Angus
authors.forename: Kim
authors.initials: K
authors.lastname: Corace
authors.forename: Susan M
authors.initials: SM
authors.lastname: Barry-Bianchi
authors.forename: Maggie H
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003159:Community-Institutional Relations; D003327:Coronary Disease / Q000517:prevention & control*; D003376:Counseling / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012307:Risk Factors; D016037:Single-Blind Method; D017216:Telemedicine / Q000379:methods*