Technology Evaluation: A Randomized Trial of Electronic Clinical Reminders to Improve Quality of Care for Diabetes and Coronary Artery Disease Computerized community cholesterol control (4C): meeting the challenge of secondary prevention. Community-based comprehensive lifestyle programs in patients with coronary artery disease: Objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2). Translating research into practice using electronic medical records the PPRNet-TRIP project: primary and secondary prevention of coronary heart disease and stroke. Secondary Prevention Risk Interventions Via Telemedicine and Tailored Patient Education (SPRITE): A Randomized Trial to Improve Postmyocardial Infarction Management The TeleGuard trial of additional telemedicine care in CAD patients. 2 Morbidity and mortality after 12 months A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol Pilot study examining the efficacy of an electronic intervention to promote HIV medication adherence Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Secondary Prevention After Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation Into Practice [Impact of multifactor intensive intervention on self management, risk factor control and outcome of post percutaneous transluminal coronary intervention patients]. Electronic messaging support service programs improve adherence to lipid-lowering therapy among outpatients with coronary artery disease: an exploratory randomised control study. Effects of a psychoeducational intervention for secondary prevention in Korean patients with coronary artery disease: a pilot study. Effectiveness of two preventive interventions for coronary heart disease in primary care. A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD) - rationale and design of a multicenter, randomized trial in depressed patients with CAD. Improving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients
OBJECTIVE The aim of this study was to evaluate the impact of an integrated patient-specific electronic clinical reminder system on diabetes and coronary artery disease ( CAD ) care and to assess physician attitudes toward this reminder system . DESIGN We enrolled 194 primary care physicians caring for 4549 patients with diabetes and 2199 patients with CAD at 20 ambulatory clinics . Clinics were r and omized so that physicians received either evidence -based electronic reminders within their patients ' electronic medical record or usual care . There were five reminders for diabetes care and four reminders for CAD care . MEASUREMENTS The primary outcome was receipt of recommended care for diabetes and CAD . We created a summary outcome to assess the odds of increased compliance with overall diabetes care ( based on five measures ) and overall CAD care ( based on four measures ) . We surveyed physicians to assess attitudes toward the reminder system . RESULTS Baseline adherence rates to all quality measures were low . While electronic reminders increased the odds of recommended diabetes care ( odds ratio [ OR ] 1.30 , 95 % confidence interval [ CI ] 1.01 - 1.67 ) and CAD ( OR 1.25 , 95 % CI 1.01 - 1.55 ) , the impact of individual reminders was variable . A total of three of nine reminders effectively increased rates of recommended care for diabetes or CAD . The majority of physicians ( 76 % ) thought that reminders improved quality of care . CONCLUSION An integrated electronic reminder system result ed in variable improvement in care for diabetes and CAD . These improvements were often limited and quality gaps persist BACKGROUND Dyslipidemia remains underdiagnosed and undertreated in patients with coronary artery disease . The Computer-based Clinical Decision Support System provides an opportunity t close these gaps . OBJECTIVES To study the impact of computerized intervention on secondary prevention of CAD . METHODS The CDSS was programmed to automatically detect patients with CAD and to evaluate the availability of an up date d  lipoprotein profile  and treatment with lipid-lowering drugs . The program produced automatic computer-generated monitoring and treatment recommendations . Adjusted primary clinics were r and omly assigned to intervention ( n=56 ) or st and ard care arms ( n=56 ) . Reminders were mailed to the primary medical teams in the intervention arm every 4 months updating them with current lipid levels and recommendations for further treatment . Compliance and lipid levels were monitored . The study group comprised all patients with CAD who were alive at least 3 months after hospitalization . RESULTS Follow-up was available for 7448 patients ( median 19.8 months , range 6 - 36 months ) . Overall , 51.7 % of patients were adequately screened , and 55.7 % of patients were compliant with treatment to lower lipid level . In patients with initial low density lipoprotein  > 120 mg/dl , a significant decrease in LDL levels was observed in both arms , but was more pronounced in the intervention arm : 121.9 + /- 34.2 vs. 124.3 + /- 34.6 mg/dl ( P < 0.02 ) . A significantly lower rate of cardiac rehospitalizations was documented in patients who were adequately treated with lipid-lowering drugs , 37 % vs. 40.9 % ( P < 0.001 ) . CONCLUSIONS This initial assessment of our data represent a real-world snapshot where physicians and CAD patients often do not adhere to clinical guidelines , presenting a major obstacle to implementing effective secondary prevention . Our automatic computerized reminders system substantially facilitates adherence to guidelines and supports wide-range implementation UNLABELLED Patients with coronary artery disease ( CAD ) are at high risk of recurrent events . A healthy lifestyle can significantly reduce this risk . A previous trial , R and omized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists ( RESPONSE ) , demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors . However , lifestyle-related risk factors , including smoking , overweight , and physical inactivity , were common and remained largely unchanged at follow-up in most patients ( 66 % ) . The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD . We are conducting a multicenter ( n = 15 ) , r and omized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs , aim ed at patients and their partners , on top of usual care . These programs are aim ed at smoking cessation ( Luchtsignaal ( ® ) ) , weight loss ( Weight Watchers ( ® ) ) , and improving physical activity ( Philips DirectLife ( ® ) ) . OUTCOMES The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2 , and a relative increase of at least 30 % in this proportion is considered clinical ly relevant This paper describes the background and methods of an Agency for Healthcare Research and Quality -funded study design ed to evaluate the impact of a  quality improvement model  using academic detailing and electronic medical records ( EMRs ) on adherence with 22 clinical practice guidelines for prevention of cardiovascular disease and stroke . The study is being conducted in 23 primary care practice s in 14 states that use a common EMR and pool data for research . Control practice s receive copies of the clinical practice guidelines and quarterly up date s of their adherence with them . Intervention practice s receive similar information and participate in regular site visits and investigator meetings design ed to catalyze their quality improvement efforts . The intervention began January 1 , 2001 and will be completed on June 30 , 2003 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 infa rct ion and hypertension into a 3-arm r and omized , 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 st and ard care ( n=150 ) . All participants will have an in-person assessment at baseline and at completion of the study , including st and ardized 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 st and ard 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 . Conclusion — 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 . clinical trials.gov . Unique identifier : NCT00901277 Summary In the TeleGuard trial , 1500 patients with established coronary artery disease ( CAD ) were recruited and r and omized to control or intervention groups . Patients in the intervention group were equipped with a 12-lead event recorder and could contact a call centre and transmit an ECG whenever they wished . In a 12-month study , the composite endpoint ( all-cause mortality , myocardial infa rct ion , re-hospitalization or re-vascularization ) was seen in 40 % of the intervention patients and in 38 % of the control patients . In both groups , approximately 40 % were re-hospitalized . In total , 73 patients experienced re-vascularization , 75 showed an infa rct ion and 33 died . Equipping CAD patients with a 12-lead ECG device and providing a telemedicine centre with 24-hour availability did not decrease risk for the composite endpoint ( re-hospitalization , re-vascularization , ( subsequent ) myocardial infa rct ion and /or death ) . It is likely that the clinical pathway used in the telemedicine centre led to an increased hospital admission rate in the intervention group Introduction Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk . In this project , we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice . Consumer Navigation of Electronic Cardiovascular Tools ( CONNECT ) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Isl and er and non-indigenous adults , recruited through primary care , at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care . Methods and analysis R and omised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk . The trial will be augmented by formal economic and process evaluations to assess acceptability , equity and cost-effectiveness of the intervention . The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management . The programme is electronically integrated with the primary care provider 's software and will include interactive smart phone and Internet platforms . The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline -recommended blood pressure ( BP ) and cholesterol targets . Secondary outcomes include change in mean BP and fasting cholesterol levels , proportion meeting BP and cholesterol targets separately , self-efficacy , health literacy , self-reported point prevalence abstinence in smoking , body mass index and waist circumference , self-reported physical activity and self-reported medication adherence . Ethics and dissemination Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences Clinical Trials registration number ACTRN12613000715774 Widespread dissemination of current interventions design ed to improve HIV medication adherence is limited by several barriers , including additional time and expense burdens on the health care systems . Electronic interventions could aid in dissemination of interventions in the clinic setting . This study developed and tested the feasibility and acceptability of a computer-based adaption of an empirically supported face-to-face adherence promotion intervention . HIV-positive individuals ( N = 92 ) on antiretroviral therapy with self-reported adherence < 95 % were r and omized to the electronic intervention + treatment as usual ( TAU ) or TAU only . Study outcome variables which included treatment self-efficacy and self-reported medication adherence were assessed at baseline and follow-up . Time × condition interaction effects in mixed model analysis of variance ( ANOVAs ) examined the differences in patterns of change in the outcome variables over time between the two groups . Participants in the electronic intervention condition reported higher levels of self-efficacy to adhere to their medication at follow-up compared to the control condition . Although nonsignificant , levels of adherence tended to improve over time in the intervention condition , while TAU adherence remained constant . This was the first study to investigate a single-session , computer-based adherence intervention . Results suggest that electronic interventions are feasible and this method may be effective at increasing self-efficacy and adherence among patients reporting suboptimal adherence levels BACKGROUND Treatment of coronary artery disease ( CAD ) is evolving with better medications , improvements in percutaneous coronary intervention ( PCI ) , and enhanced techniques for coronary artery bypass grafting ( CABG ) . METHODS In this study , 18,481 patients with significant ( > 75 % stenosis ) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy : medical therapy ( MED ) ( n = 6862 ) , PCI ( n = 6292 ) , or CABG ( n = 5327 ) . Each group was categorized into 3 groups according to baseline severity of CAD : low-severity ( predominantly 1-vessel ) , intermediate-severity ( predominantly 2-vessel ) , and high-severity ( all 3-vessel ) , and prospect ively evaluated in Cox models for all-cause mortality adjusted for cardiac risk , comorbidity , and propensity for selection of a specific treatment . Treatments were compared for the entire period and three eras ( 1 : 1986 to 1990 ; 2 : 1991 to 1995 ; 3 : 1996 to 2000 ) , the last encompassing widespread availability of PCI with stenting . RESULTS Survival significantly improved in all groups for all degrees of CAD , despite increasing severity of illness . Revascularization strategies provided significant survival over MED with 8.1 , 10.6 , and 23.6 additional months per 15 years of follow-up for low-severity , intermediate-severity , and high-severity CAD , respectively . Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up ( 95 % confidence interval , 0.2 to 10.2 ; p = 0.039 ) in era 3 for CABG compared with PCI for high-severity CAD . CONCLUSIONS Initial revascularization strategies result in significant survival advantage over MED for all CAD levels . Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG Background — Despite evidence supporting the use of aspirin , & bgr;-blockers , angiotensin-converting enzyme inhibitors , and lipid-lowering therapies in eligible patients , adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent . We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting . Methods and Results — A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Data base and treating 361 328 patients undergoing isolated coronary artery bypass grafting were r and omized to either a control or an intervention group . The intervention group received continuous quality improvement material s design ed to influence the prescription of the secondary prevention medications at discharge . The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications at intervention versus control sites , assessed by measuring preintervention and postintervention site differences . Prer and omization treatment patterns and baseline data were similar in the control ( n=234 ) and treatment ( n=224 ) groups . Individual medication use and composite adherence increased over 24 months in both groups , with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 secondary prevention medications . Conclusions — Provider-led , low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure . The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement OBJECTIVE To test the efficacy of multifactor intensive intervention for post percutaneous transluminal coronary intervention ( post-PCI ) out patients on self management , risk factor control and outcome . METHODS A total of 263 patients with coronary heart disease ( CAD ) discharged from our cardiac center were r and omized into usual care ( 4 CAD lectures focusing on the 2(nd ) CAD prevention and patients -oriented outpatient visit ) and intensive intervention ( 4 CAD lectures focusing on the 2(nd ) CAD prevention , CAD outpatient visit twice a month , monthly telephone instructions on risk factor control and optimal medication ) . Patients were followed for 12 months and 250 patients completed follow-up . RESULTS There were more patients achieved a LDL-C level of less than 2.6 mmol/L in intensive intervention group than in usual care group ( 71.2 % vs. 48.3 % , P < 0.01 ) . The percentages of patients taking  dietary control  ( 55.3 % vs. 26.2 % , P < 0.01 ) and  physical exercises  ( 64.4 % vs. 39.0 % , P < 0.01 ) , receiving  beta-adrenergic receptor blocker  ( 75.0 % vs. 50.8 % , P < 0.01 ) and  statins  ( 72.0 % vs. 54.2 % , P < 0.01 ) were significantly higher while cardiovascular event rate ( 5.9 % vs. 0 % , P = 0.005)was significantly lower in intensive intervention group than in usual care group . CONCLUSION Multifactor intensive intervention is helpful on improving the second prevention for post-PCI coronary heart disease patients AIMS AND OBJECTIVES To compare drug adherence to lipid-lowering therapy among out patients with coronary artery disease who received information via short message service , via short message service and Micro Letter , or via phone only .  BACKGROUND Messaging applications and short message service are commonly used internationally . However , little is known about how coronary artery disease out patients in China may benefit from receiving health education through these technologies . DESIGN R and om sampling method . METHODS Data were collected from March-December 2013 . Subjects from Chengdu City , China , were r and omised to three groups : short message service , short message service + Micro Letter , and phone ( control ) . Appointment reminders and health information were delivered to patients in accordance with design ations . After six months , adherence to statin prescriptions was compared among the groups by using the Morisky Medication Adherence Scale . Logistic regression analysis was applied to determine those independent variables that were related to adherence . RESULTS The short message service and short message service + Micro Letter groups had better cumulative adherence ( lower Morisky Medication Adherence Scale scores ) after six months than phone group , and the short message service + Micro Letter group had better cumulative adherence ( lower Morisky Medication Adherence Scale scores ) than the short message service group . Female sex , older age and marriage show positive associations with adherence . CONCLUSIONS Short message service and messaging applications , such as Micro Letter , are effective means of providing discharged patients with reminders and coronary artery disease-related health information . Implementation of a short message service + Micro Letter program can improve outpatient adherence to medication . RELEVANCE TO CLINICAL PRACTICE This research offers useful information to help medical staff design effective interventions to improve medication compliance among coronary artery disease patients This intervention study was design ed to examine whether a 12-week psychoeducational intervention influenced recurrent cardiac events , symptom experience and treatment adherence of patients with coronary artery disease . Fifty-eight patients were r and omized to either the intervention or the control group . Measures were taken at baseline , after intervention , and at 6-month follow-up . Recurrent cardiac events included revascularization , rehospitalization , emergency room visits and mortality . Symptom experiences were measured using the Seattle Angina Question naire-Korean and Hospital Anxiety and Depression Scale . Treatment adherence included  health behaviours , routine check-up and medication adherence .  At 6-month follow-up , the intervention group had significantly better physical functions and lower anxiety and depressive symptoms . Treatment adherence was also significantly higher in the intervention group than the control group . No significant difference was noticed in the incidence of recurrent cardiac events between the groups . A longer follow-up study is needed to determine the long-term effects on the prevention of recurrent cardiac events OBJECTIVES 1 . To compare a patient-centred , self-directive intervention with conventional care ; 2 . To evaluate longitudinal within-group changes of coronary heart disease risk . METHODS Risk factor changes were evaluated in 110 men with high coronary heart disease risk attending a one year intervention study in general practice . The 22 participating general practice centres were r and omly allocated to follow either a patient-centred , self-directive intervention or a conventional approach . RESULTS No significant between-group differences were found in any single risk factor or in the combined risk of coronary heart disease . The improvement of total risk from screening time to conclusion of the study corresponded with changes of relative risks of CHD to 0.64 ( 95 % CI : 0.54 - 0.77 ) and 0.65 ( 0.54 - 0.77 ) in the patient-centred , self-directive and the conventional care group respectively ( p < 0.0001 in both groups ) . CONCLUSION Everyday general practice clinical work seems as efficacious as a specific intervention method based on currently advocated behaviour change principles OBJECTIVE Depressive symptoms are highly relevant for the quality of life , health behavior , and prognosis in patients with coronary artery disease ( CAD ) . However , previous psychotherapy trials in depressed CAD patients produced small to moderate effects on depression , and null effects on cardiac events . In this multicentre psychotherapy trial , symptoms of depression are treated together with the Type D pattern ( negative affectivity and social inhibition ) in a stepwise approach . METHODS Men and women ( N=569 , age 18 - 75 years ) with any manifestation of CAD and depression scores ≥ 8 on the Hospital Anxiety and Depression Scale ( HADS ) , will be r and omized ( allocation ratio 1:1 ) into the intervention or control group . Patients with severe heart failure , acutely life-threatening conditions , chronic inflammatory disease , severe depressive episodes or other severe mental illness are excluded . Both groups receive usual medical care . Patients in the intervention group receive three initial sessions of supportive individual psychotherapy . After re-evaluation of depression ( weeks 4 - 8 ) , patients with persisting symptoms receive an additional 25 sessions of combined psychodynamic and cognitive-behavioral group therapy . The control group receives one psychosocial counseling session . Primary efficacy variable is the change of depressive symptoms ( HADS ) from baseline to 18 months . Secondary endpoints include cardiac events , remission of depressive disorder ( SCID ) and Type D pattern , health-related quality of life , cardiovascular risk profile , neuroendocrine and immunological activation , heart rate variability , and health care utilization , up to 24 months of follow-up ( IS RCT N : 76240576 ; NCT00705965 ) . Funded by the German Research Foundation Background Cardiac rehabilitation ( CR ) is a secondary prevention program that offers education and support to assist patients with coronary heart disease ( CHD ) make lifestyle changes . Despite the benefits of CR , attendance at centre-based sessions remains low . Mobile technology ( mHealth ) has potential to reach more patients by delivering CR directly to mobile phones , thus providing an alternative to centre-based CR . The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours ( for example , physically active , fruit and vegetable intake , not smoking , low alcohol consumption ) over and above usual CR services in New Zeal and adults diagnosed with CHD . Methods / design A two-arm , parallel , r and omised controlled trial will be conducted at two Auckl and hospitals in New Zeal and . One hundred twenty participants will be r and omised to receive a 24-week evidence - and theory-based personalised text message program and access to a supporting website in addition to usual CR care or usual CR care alone ( control ) . The primary outcome is the proportion of participants adhering to healthy behaviours at 6 months , measured using a composite health behaviour score . Secondary outcomes include overall cardiovascular disease risk , body composition , illness perceptions , self-efficacy , hospital anxiety/depression and medication adherence . Discussion This study is one of the first to examine an mHealth-delivered comprehensive CR program . Strengths of the trial include quality research design and in-depth description of the intervention to aid replication . If effective , the trial has potential to augment st and ard CR practice s and to be used as a model for other disease prevention or self-management programs . Trial registryAustralian New Zeal and Clinical Trials Registry : Background The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention
The m-Health programmes reported positive effects on adherence to medication .
Conclusion Evidence exists that supports the use of e-Health interventions for improving secondary prevention of CAD .
However , a comparison across studies highlighted a wide variability of components and outcomes within the different modes of delivery .
Background Electronic health ( e-Health ) interventions are emerging as an effective alternative model for improving secondary prevention of coronary artery disease ( CAD ) .
The aim of this study was to describe the effectiveness of different modes of delivery and components in e-Health secondary prevention programmes on adherence to treatment , modifiable CAD risk factors and psychosocial outcomes for patients with CAD .