Modes of e-Health delivery in secondary prevention programmes for patients with coronary artery disease: a systematic review
Open accessAbstract
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. METHOD: A systematic review was carried out based on articles found in MEDLINE, CINAHL, and Embase. Studies evaluating secondary prevention e-Health programmes provided through mobile-Health (m-Health), web-based technology or a combination of m-Health and web-based technology were eligible. The main outcomes measured were adherence to treatment, modifiable CAD risk factors and psychosocial outcomes. The quality appraisal of the studies included was conducted using the Joanna Briggs Institute critical appraisal tool for RCT. The results were synthesised narratively. RESULT: A total of 4834 titles were identified and 1350 were screened for eligibility. After reviewing 123 articles in full, 24 RCTs including 3654 participants with CAD were included. Eight studies delivered secondary prevention programmes through m-Health, nine through web-based technology, and seven studies used a combination of m-Health and web-based technology. The majority of studies employed two or three secondary prevention components, of which health education was employed in 21 studies. The m-Health programmes reported positive effects on adherence to medication. Most studies evaluating web-based technology programmes alone or in combination with m-Health also utilised traditional CR, and reported improved modifiable CAD risk factors. The quality appraisal showed a moderate methodological quality of the studies. 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. High quality trials are needed to define the most efficient mode of delivery and components capable of addressing a favourable outcome for patients. TRIAL REGISTRATION: Not applicable.
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The current quality level of trials in this field is moderate.
“High quality studies are warranted due to the current moderate quality level of trials in this field [30].”
Two studies delivered such an intervention in addition to traditional cardiac rehabilitation.
“Two studies delivered such intervention in addition to traditional CR [30].”
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- Authors
- Brørs, G., Pettersen, T. R., Hansen, T. B., Fridlund, B., Hølvold, L. B., Lund, H., & Norekvål, T. M.
- Affiliations
- Namsos Hospital (NO)
- Haukeland University Hospital (NO)
- University of Southern Denmark (DK)
- Linnaeus University (SE)
- Western Norway University of Applied Sciences (NO)
- Corresponding author
- Norekvål, Tone M.
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2019-06-10
- Volume
- 19
- Issue
- 1
- Pages
- 364-364
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC6558849
- OpenAlex
- W2950476514
- Cited by
- 67
- References
- 67
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 18 · 2022: 13 · 2021: 11 · 2020: 5 · 2019: 1
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
- Funders
- Helse Vest (912184)
- Helse Nord-Trøndelag (18/3742)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- e-health, secondary prevention, coronary artery disease, mobile health, online intervention, medication adherence, modifiable risk factors, psychosocial outcomes, health education, cardiac rehabilitation
- MeSH terms
- Cardiac Rehabilitation, Coronary Artery Disease, Health Promotion, Humans, Prospective Studies, Telemedicine, Secondary Prevention
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