Study Rationale:

Reduction of risk factors, chronic disease prevention and support for self-care management have all been cited as major initiatives both Federally and Provincially. This RCT tests the hypothesis that telehealth support and report card feedback are efficacious in reduction of risk factors associated with cardiovascular disease.

Objective:

The objective of the 5-year "Cardiovascular Health Best Practice Project" is to establish whether the decreased risk of a heart event is achievable through risk factor modification using a low-intensity lifestyle intervention based upon an expert patient model.

Methods:

Eligibility to participate in the study included: age 45-64; resident of the Fraser Health area; with a >=10% absolute risk for cardiovascular disease over ten years (based on the Framingham calculator). Recruitment included family physician offices and work sites within Fraser Health. The primary prevention group of subjects were triaged using Framingham risk assessment as moderate or high risk for coronary heart disease development. The Simon Fraser Heart Health Report Card System(C) is an intervention that provides an annual report card for subjects and their primary care physicians, and tailored behavioural lifestyle telehealth counseling provided by American College of Sports Medicine certified kinesiologists trained as lifestyle counselors. Report Cards are based on the Framingham risk assessment scoring methodology and provide risk scores and target levels for major risk factors and behavioural changes (smoking, exercise, nutrition, stress and medication compliance).

Results:

Preliminary one-year follow-up data is available for the primary prevention arm of this RCT in 180 of 310 subjects. The mean Framingham 10-year absolute risk score for treatment subjects decreased from 12.0% to 9.37%, whereas the control group risk score decreased from 10.5% to 10.38%. The treatment/control difference over time was statistically significant after controlling for age, sex, SF-36, education, income and living arrangement using ANOVA (F = 4.85, P < .05). Statistically significant group differences over time were also found for total cholesterol (F = 4.27, P < .05), nutrition level (F = 4.85, P < .05), and for level of physical activity (t = 2.1, P < .05), blood pressure (t = -2.0, P < .05) at the bivariate level.

Conclusions:

Analyses of these data provide support for the efficacy of this telehealth report card counselling approach. Risk factors were significantly reduced in preliminary data and mean Framingham 10-year absolute risk score decreased significantly. The Simon Fraser Heart Health Report Card System(C) could be used in rural as well as urban settings, increasing access to information and support at minimal costs. Further study is needed of this unique approach to cardiovascular risk reduction and chronic disease prevention.

Section Description

For more information, contact Marilyn Thomas (204) 488-5854