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Table 3 Characteristics of studies included in the systematic review of randomized controlled trials assessing the effectiveness of e-Health interventions as part of a secondary prevention programme for patients with coronary artery disease (N = 23)

From: Modes of e-Health delivery in secondary prevention programmes for patients with coronary artery disease: a systematic review

Reference and country Intervention arm Control group Sample size Population Mean age (SD) Men (%) Outcome measure Measurement time points Effects of the intervention Intervention use
m-health
Thakkar et al. 2016 [27] Australia. Text messages in addition to traditional exercise based CR. Traditional exercise based CR. 710 (IG:352 CG: 358) Patients with CAD. 57.6 (9.18) 81.9 PO: Physical activity. Baseline and after 6 months. Effects on physical activity. Seven patients requested the text messages to be stopped during follow-up.
Chow et al. 2016 [28] Australia. Text messages in addition to traditional exercise based CR. Traditional exercise based CR. 710 (IG:352 CG: 358) Patients with CAD. 57.6 (9.18) 81.9 PO: LDL-cholesterol level at 6 months. SO: Systolic blood pressure, heart rate, total cholesterol level, BMI, waist circumference, total physical activity, smoking status, proportion achieving guideline levels of modifiable risk factors, and adherence to medications. Baseline and after 6 months. Effects on LDL-cholesterol level, systolic blood pressure, BMI and smoking Seven patients requested the text messages to be stopped during follow-up.
Johnston et al. 2016 [30] Sweden. An interactive web-based smartphone application and standard secondary prevention care A simplified Web-based smartphone application and standard secondary prevention care. 174 (IG:91 CG: 83) Ticagrelor-treated MI patients. 58 (8) 81 PO: Adherence to Ticagrelor, BMI, physical activity, smoking cessation, quality of life. SO: Patient medication use. Quality of life. Tools impact on CV risk factors, use of the tool over time, system usability and satisfaction, safety of the tool. Evaluated at visit 2, 3 and after 6 months. Effect on self-reported medication adherence in e-diary. The proportion of patients who prematurely stopped using the e-diary was low and did not differed between the 2 study groups.
Fang et al. 2016 [32] China. A: Personalized text messages. B: Personalized text messages and a smartphone application. Telephone call. 280 (IGa:95;IGb:92 CG: 93) Patients with chronic stable angina. 53.6 71 PO: Self-reported medication adherence. Baseline and after 6 months. No effect  
Park et al. 2015 [37] USA. A: Text messages for medication reminders and education. B: Text messages for education. No text messages. 90 (IGa:30 IGb:30 CG: 30) Patients hospitalized for ACS. 52.9 (9.4) 75 PO: Patient self-reported medication adherence, self-efficacy. SO: Social support, depression. Baseline and after 30 days. Effect in the percentage of prescribed number of dose taken, correct doses taken and doses taken on schedule.  
Khonsari et al.2015 [39] Kuala Lumpur. Text messages medication reminders. Cardiac rehabilitation and follow-up appointments with cardiologist. 62 (IG:31 CG: 31) Patients with ACS. 57.9 (12.64) 85.5 PO: The ratio of adherent patients to complete cardiac medication therapy. SO: Heart functional status (NYHA), ACS-related hospital readmission and death rates. Baseline and after 8 weeks. Effect in self-reported medication adherence, heart functional status. 93.5% said the system was useful and 64.5% felt that it had helped them taking their medications. 80% requested for the SMS reminders to be continued.
Park et al. 2014 [38] USA. A: Text messages for medication reminders and education. B: Text messages for education. No text messages. 90 (IGa:30 IGb:30 CG: 30) Patients hospitalized for ACS. 52.9 (9.4) 75 PO: Medication adherence.SO: Feasibility and patient satisfaction. Baseline and after 30 days. Effect in the percentage of prescribed number of dose taken, correct doses taken and doses taken on schedule.  
Blasco et al. 2012 [44] Spain. m-health application including telemonitoring and text messages, lifestyle counseling and three clinical visits. Three clinical visits and lifestyle counseling. 203 (IG:102 CG: 101) Patients with ACS. 61 (11.5) 83 PO: Cardiovascular risk improvement. SO: Proportion of patients achieving treatment goals, quality of life, anxiety. Baseline and after 12 months. Effect in cardiovascular risk factors and treatment goals for blood pressure, BMI, and HbA1c. Reasons for leaving the programme in the TMG were stress associated with the use of the telemonitoring equipment in 3 patients, personal reasons in 7, and inability to handle the equipment in 2 patients.
Web-based technology
Norlund et al. 2018 [26] Sweden. Therapist-guided, tailored Web-based cognitive behavioural therapy. 10 modules with different themes, each containing 2 to 4 treatment steps. Standard local healthcare. 239 (IG:117 CG: 122) Patients with a recent MI and symptoms of depression or anxiety. 59.6 (8.49) 67.5 PO: Anxiety and depression. SO: Cardiac anxiety, depression and suicidal ideation. Baseline and after 14 weeks. No effect. Treatment adherence was low.
Vieira et al. 2018 [47] Portugal. A: Virtual reality programme (Kinect) and education on cardiovascular risk factors. B: Paper booklet and education on cardiovascular risk factors. Education on cardiovascular risk factors. 46 (IGa:15; IGb:15, CG: 16) Patients with CAD. 66 100 PO: Executive function. SO: Quality of life, depression, anxiety, stress. Baseline and after 3 and 6 months. Effects in executive function for IG1 (selective attention and conflict resolution ability). The IG1: 82% participated in the first 3 months and 70% in the last three. The IG2: 90% participated in the first 3 months and 75% in the last 3 months.
Vieira et al. 2017. Portugal. [48] A: A virtual reality programme (Kinect) and education on cardiovascular risk factors. B: A paper booklet and education on cardiovascular risk factors. Education on cardiovascular risk factors. 46 (IGa:15; IGb:15, CG: 16) Patients with CAD. 66 100 PO: Bioimpedancce, BMI, waist to hip circumference, and body composition. SO: Physical activity, eating habits, and lipid profile. Baseline and after 3 and 6 months. Effects in waist-to-hip ratio, ingestion of total fat and HDL cholesterol level. The IG1: 82% participated in the first 3 months and 70% in the last three. The IG2: 90% participated in the first 3 months and 75% in the last 3 months.
Lear et al. 2015 [36] Canada. Virtual CR programme with on-line intake forms, scheduled chat sessions with nurse, exercise specialist and dietitian, education sessions, data capture for stress test and blood test results, monthly ask-an-expert group chat. Simple guidelines for safe exercising and healthy eating, and a list of internet resources. 78(IG:38 CG: 40) Patients with CAD. 60 85 PO: Exercise capacity. SO: Lipid profile, blood glucose, Blood pressure, smoking status, BMI, waist circumference, physical activity, diet, hospital admission and emergency room visits. Baseline and after 4 and 16 months. Effect in Exercise capacity. The median number of website logins per person was 27. 122 one-to -one private chat sessions.
Devi et al. 2014 [41] England. Web-based CR. Tailored goals on exercise, diet, emotions and smoking. Online exercise diary. Feedback on physical activity and smoking. Information on CAD-related risk factors. Care from the GP and attending an annual check of risk factor management with a nurse. 94 (IG:48 CG: 46) Patients diagnosed with angina. 66.27 (8.35) 74 PO: Daily average step count, SO: Energy expenditure, duration of sedentary activity, and duration of moderate activity. Weight, blood pressure and body fat percentage, fat and fiber intake, anxiety and depression, self-efficacy, quality of life. Baseline, 6 weeks after randomization and then 6 months after the 6-week follow-up. Effect in step-count, energy expenditure, self-efficacy, weight, emotional quality of life score and angina frequency. The mean number of logins to the program was 18.68, an average of 3 logins per week per participant. Five patients felt trial was too burdensome.
Vernooij et al. 2012 [43] Netherlands. Internet-based risk factor management programme and usual care. Physician at the hospital or general practitioner for risk factor management. 330 (IG:164 CG: 166) Patients with atherosclerosis in the coronary (49%), cerebral or peripheral arteries. 59.9 (8.4) 75 PO: The relative change in Framingham heart risk score after 1 year. SO: The absolute changes in levels of risk factors, differences between groups in the change in proportion of patients reaching treatment goals for each risk factor. Baseline and after 12 months. No effect (a relative change of −12% in Framingham heart risk score). 152 patients logged inn at a median of 56 times during the year. Patients (n = 134) sent a median 14 messages, and 131 patients entered a median 7 measurements. The monthly number of logins decreased during the intervention period.
Reid et al. 2011 [45] England. Physical-activity plan and access to a website for planning and tracking, and motivational feedback. Attending a cardiologist and education booklet. 223 (IG:115 CG: 108) Patients with ACS. 56.4 84.3 PO: Physical activity: the average number of steps per day. SO: Self-reported leisure-time physical activity, heart disease health-related quality of life. Baseline, and after 6 and 12 months. Effects in physical activity, emotional and physical dimensions of quality of life. 61.7% of participants completed at least three of the five tutorials. Thirty-seven participants emailed the exercise specialist at least once.
Lindsay et al. 2009 [46] England. Moderated web-based discussion groups. Unmoderated online discussion group. 108 (IG:54 CG: 54) Patients with CAD. 62.9 66 PO: Changes in health behaviour. Baseline and after 6 and 9 months. Effects in self-reported diet during moderated phase. Message writing to moderators decreased from the moderated to the unmoderated phase, while message writing between participants increased.
Southard et al. 2003 [49] USA Web-based interactive educational programme Usual care. 104 (IG: 53 CG: 51) Patients with CAD. 62.3 (10.6) 75 PO: Diastolic blood pressure, height, weight, LDL levels, exercise, diet, depression, economic evaluation. Baseline and after 6 months. Effect on weight loss and BMI, On average, the individuals in the IG group logged on to the Web site 58 times over the course of the 6-month intervention, or approximately two times per week.
Combination
Widmer et al. 2017 [29] USA. Web- and smartphone-based CR in addition to standard phase II CR. A standard phase II CR. 80 (IG:40 CG: 40) Patients after PCI for ACS. 62.5 (10.7) 78 PO: CV-related ED visits and readmissions. SO: Weight, blood pressure, heart rate, glucose/HbA1c, lipids, physical activity, diet, quality of life, mood, compliance. Baseline and after 3 months. Effect on weight reduction. 16% continued to use the application after 3 months.
Wolf et al. 2016 [31] Sweden A: Person-centered care in addition to a Web- and mobile-based application. B: Person-centered care. Usual care. 199 (IGa:37; IGb: 57; CG: 105) Patients with ACS. 60 (10) 75 PO: Changes in general self-efficacy. SO: Return to work or prior activity level, rehospitalization or death 6 months after discharge. Baseline and after 6 months. Effect in general self-efficacy. The majority used the mobile app rather than the web-based app as the primary source. Patients used the eHealth tool a mean of 38 times during the first 8 weeks and 64 times over a 6-month period.
Pfaeffli Dale et al. 2015 [33] New Zealand. Personalized text messages and web-page portal in addition to standard CR. Standard CR. 123 (IG:61 CG: 62) Patients with CAD. 59.5 (11.1) 81 PO: Adherence to recommended health guidelines, subsequent CAD risk probability. SO: Biomedical risk factors, self-reported medication adherence, self-efficacy, illness perception, anxiety and depression, serious adverse event data. Baseline and after 3 and 6 months. Effect on adherence to recommended health guidelines and self-reported medication adherence. All but one in the IG received the Text4Heart programme. High fidelity to the text messaging component. 85% read all their text messages. 79% felt that 24-week programme was the right length.
Maddison et al. 2015 [34] New Zealand. Web-site and text messages in addition to community-based CR. Community-based CR. 171 (IG:85 CG: 86) Patients diagnosed with CAD. 60 (9.3) 81 PO: Change in PVO2. SO: Self-reported physical activity, self-efficacy and motivation to exercise, health related quality of life. Economic evaluation. Baseline and after 24 weeks. Effect in leisure time physical activity and walking, self-efficacy to be active and the general health domain of quality of life. 82% of participants read some or all of the HEART text messages and 57% of participants viewed some or all of the video messages on the web-site. On average participants viewed the website once every 2 weeks.
Frederix et al. 2015 [35] Belgium. Tele-rehabilitation programme in addition to conventional CR. Conventional CR. 140 (IG:70 CG: 70) Patients entered cardiac rehabilitation for CAD or heart failure. 61 (9) 81 PO: VO2 peak. SO: Accelerometer-recorded daily step counts, self-assessed physical activity, HbA1c, glycemic control, lipid profile, quality of life. Baseline and after 6 and 24 weeks. Effect in VO2 peak, self-reported physical activity, and health-related quality of life. 97% patients reported that the telerehabilitation’s motion sensor was easy to read and use. 89% were willing to use the system after study completion.
Frederix et al. 2015 [40] Belgium. Telemoni-toring and personalized feedback in addition to CR. CR phase II. 80 (IG:40 CG: 40) Patients with ACS. 60 (10) 83 PO: Hba1c, lipid profile, VO2 peak, waist circumference, blood pressure, BMI. Re-hospitalization. Baseline, and after 6 and 18 weeks. Effects in HbA1c, HDL, VO2 peak.  
Varnfield et al. 2014 [42] Australia. Text messages and web-based smartphone application. Traditional center-based CR. 120 (IG:60 CG: 60) Post-MI patients referred to CR. 55.7 (10.4) 82 PO: Uptake, adherence and completion of a CR programme. SO: Modifiable lifestyle factors, biomedical risk factors, waist circumference, lipid profile, health related quality of life. Baseline, 6-weeks and 6-months. Effects in uptake, adherence and completion rates, quality of life, blood pressure.  
  1. Abbreviations: ACS Acute coronary syndrome, BMI Body mass index, CAD Coronary artery disease, CG Control group, CR Cardiac rehabilitation, CV cardiovascular, HbA1c Hemoglobin A1c, HDL High density lipoprotein, IG Intervention group, LDL Low density lipoprotein, MI Myocardial infarction, PCI Percutaneous coronary intervention, PO Primary outcome, PVO2 Peak oxygen uptake, SO Secondary outcome, VO2 peak Peak aerobic capacity