title: Secondary prevention risk interventions via telemedicine and tailored patient education (SPRITE): a randomized trial to improve postmyocardial infarction management.
abstract: BACKGROUND
  Secondary prevention by risk factor modification improves patient outcomes, yet it is often not achieved in clinical practice. Reasons for failure stem from challenges of prioritizing risk factor reduction and engaging patients in changing their behaviors. We hypothesize that a novel telemedicine intervention with tailored patient education could improve cardiovascular risk factors.
  
  
  METHODS
  To evaluate this intervention, we propose enrolling 450 patients with a recent myocardial infarction and hypertension into a 3-arm randomized, controlled trial. The first arm (n=150) will receive home blood pressure (BP) monitors plus a nurse-delivered, telephone-based tailored patient education intervention and will be enrolled into HealthVault, a Microsoft electronic health record platform. The second arm (n=150) will also receive BP monitors plus a tailored patient education intervention and be enrolled in HeartVault. However, the patient education intervention will be delivered by a Web-based program and will cover topics identical to those in the nurse-delivered intervention. Both arms will be compared with a control group receiving standard care (n=150). All participants will have an in-person assessment at baseline and at completion of the study, including standardized measurements of BP, LDL cholesterol, and glycosylated hemoglobin (in diabetic subjects). The study design will allow assessment of a telephone-based, nurse-administered disease management program versus standard care. The main outcome of interest is the reduction in systolic BP in each intervention group compared with the control group at 12 months. Secondary outcomes assessed will include reductions in LDL cholesterol, body weight, and glycosylated hemoglobin, as well as adherence to evidence-based therapies and improvement in health behaviors.
  
  
  CONCLUSIONS
  If successful in optimizing BP control, managing other coronary heart disease risk factors, and demonstrating a lower cost, the Web-based disease management tool has the potential to enhance coronary artery disease management, quality of care, and ultimately, patient outcomes. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901277.
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA. bimal.shah@duke.edu
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
authors.forename: Martha
authors.initials: M
authors.lastname: Adams
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Benjamin
authors.initials: B
authors.lastname: Powers
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Kira
authors.initials: K
authors.lastname: Royal
authors.forename: Felicia
authors.initials: F
authors.lastname: McCant
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lindquist
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D018660:Blood Pressure Monitoring, Ambulatory; D001835:Body Weight / Q000502:physiology; D008078:Cholesterol, LDL / Q000097:blood; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D012008:Recurrence; D012107:Research Design; D012307:Risk Factors; D055502:Secondary Prevention; D012984:Software; D017216:Telemedicine
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin