Risk factor modification has the potential to reduce the number of expensive cardiac-related procedures, possibly resulting in significant savings. Other than cardiac rehabilitation, there are few resources to help patients control their risk factors. An Internet-based case management system was developed to enable nurse-managers located in an acute setting to provide risk factor management to support, educate, and monitor patients with cardiovascular disease (CVD) who are located in the home. This study of an Internet-based program suggests that it may be a cost-effective alternative or supplement for those patients who do not choose to participate in cardiac rehabilitation programs.

Background: Risk factor modification has the potential to reduce the number of expensive cardiacrelated procedures, possibly resulting in significant savings. Other than cardiac rehabilitation, there are few resources to help patients control their risk factors. Nearly 80% of patients do not participate in cardiac rehabilitation programs. An Internet-based case management system was developed to enable nurse-managers located in an acute setting to provide risk factor management to support, educate, and monitor patients with cardiovascular disease (CVD) who are located in the home as a supplement to standard cardiac care. Although the risk factor management program is delivered via the Internet, the nurse manager remains the key component of the system, interacting with patients electronically via secure communication lines within the program using a format similar to email.

Methods: To determine effectiveness, a randomized clinical trial was conducted comparing standard care with care enhanced with the Internet-based risk factor management program. The trial lasted for six months and 104 patients completed the study (53 patients used the Internet program). Patients could participate if they received approval from their primary care physician or cardiologist and had acute cardiac disease (i.e., heart attack within six months). Data were collected using a number of standardized assessment tools.

Participants had to log on to the system at least once a week for 30 minutes. When on the system, patients had to communicate with the nurse manager, complete a number of assigned education modules, and record data (e.g., number of minutes of exercise, blood pressure measurements). In addition to the nurse manager, participants using the Internet-based program had access to a registered dietitian who could provide feedback regarding dietary issues by analyzing a patient food diary.

Findings: At the end of the trial, users of the Internet-based program realized significant changes to weight and body mass compared with the standard care group (loss of 3.6 lbs. vs. gain of 0.47 lbs). Overall, the users of the Internet program were "very satisfied" with the program and found it "very helpful" and "very easy/extremely easy to use", indicating they had "learned quite a bit". Physicians were "somewhat satisfied" with the Internet program, with 90% indicating they would consider referring patients to the program. A 1-week time analysis indicated that patients using the Internet program "received" a combined average of 25 minutes of care from the nurse manager and dietitian. The cost of providing the Internet program (salary and general administration costs) was calculated to be $453 US per patient over a course of six months.

Conclusions: The Internet-based case management program for secondary prevention of heart disease appears to be effective. However, additional study with a larger population of patients with CVD must be conducted to test the reliability of results reported in this study. The Internet-based program was tailored to meet the specific needs of the participating patients: these patients focused on weight loss, and the positive outcomes related to weigh control. Users of the system reported a high level of satisfaction. This Internet-based program could be potentially used as a cost-effective supplement for those patients who do not choose to participate in cardiac rehabilitation programs.

Reference: Southard BH, Southard DR, Nuckolls J. "Clinical trial of an Internet-based case management system for secondary prevention of heart disease". Journal of Cardiopulmonary Rehabilitation, 2003; 23, 341-348.

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