Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: a randomized controlled trial.
BACKGROUND
Many strategies have been evaluated to improve the prevention and control of cardiovascular (CVD) risk factors. Nursing telephonic and tele-counseling individualized lifestyle educational programs have been found to improve blood pressure control and adherence to lifestyle recommendation. This study tested the efficacy of a nurse-led reminder program through email (NRP-e) to improve CVD risk factors among hypertensive adults.


METHODS
All participants received usual CVD prevention and a guideline-based educational program. Subjects in the NRP-e group also received weekly email alerts and phone calls from a nurse care manager for 6 months. Emails contained a reminder program on the need for adherence with a healthy lifestyle based upon current guidelines. Follow-up visits were scheduled at 1, 3 and 6 months after enrollment; randomization was made centrally and blood samples were evaluated into a single laboratory.


RESULTS
The final sample consisted of 98 (control) and 100 (NRP-e) subjects (mean age 59.0 ± 14.5 years; 51.0% males). After 6 months, the following CVD risk factors significantly improved in both groups: body mass index, alcohol and fruit consumption, cigarette smoking, adherence to therapy hours, systolic and diastolic blood pressure, fasting blood glucose, low-density lipoproteins (LDL) and total cholesterol, triglycerides, and physical activity. In the NRP-e group, however, the prevalence of several behaviors or conditions at risk decreased significantly more than in the control group: obesity (-16%), low fruit consumption (-24%), uncontrolled hypertension (-61%), LDL (-56%), and total cholesterol (-40%).


CONCLUSIONS
The NRP-e improved a range of CVD risk factors. The program had low costs, required only an average of <20 min per day in addition to normal practice, and may deserve further evaluation for the inclusion among existing care management approaches.
ASL 02 Abruzzo, Italy; Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: g.cicolini@unich.it.
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Cicolini
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: v.simonetti@unich.it.
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Simonetti
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: dania.comparcini@unich.it.
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Comparcini
Hospital of Matera, Italy. Electronic address: amy.75@libero.it.
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Celiberti
Department of Biomedical Science Laboratory of Biostatistic, "G. d'Annunzio" University of Chieti, Italy. Electronic address: m.dinicola@unich.it.
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Di Nicola
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: lmcapasso@unich.it.
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Capasso
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: elena.flacco@gmail.com.
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Flacco
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: mbucci@unich.it.
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Bucci
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: mezzetti@unich.it.
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Mezzetti
Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Italy. Electronic address: l.manzoli@unich.it.
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Manzoli
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D034742:Electronic Mail; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D057184:Practice Patterns, Nurses'; D017010:Reminder Systems / Q000592:standards*; D040242:Risk Reduction Behavior
Hypertension; Nurse-led intervention; Primary prevention; Randomized controlled trial