Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial.
OBJECTIVE
To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease.


METHODS
Prospective randomised controlled trial.


METHODS
Multicentre trial in secondary and tertiary healthcare setting.


METHODS
330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal.


METHODS
Personalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment.


METHODS
The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor.


RESULTS
Participants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8% (-18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria).


CONCLUSIONS
An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease.


BACKGROUND
Clinical trials NCT00785031.
Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands.
J W P
JW
Vernooij
H A H
HA
Kaasjager
Y
Y
van der Graaf
J
J
Wierdsma
H M H
HM
Grandjean
M M C
MM
Hovens
G A
GA
de Wit
F L J
FL
Visseren
D050197:Atherosclerosis / Q000451:nursing*; D002561:Cerebrovascular Disorders / Q000451:nursing; D003324:Coronary Artery Disease / Q000451:nursing; D005260:Female; D006331:Heart Diseases / Q000451:nursing / Q000517:prevention & control; D006470:Hemorrhage / Q000451:nursing / Q000517:prevention & control; D006801:Humans; D020407:Internet; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000451:nursing; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D012308:Risk Management; D012648:Self Care / Q000379:methods; D016896:Treatment Outcome