RESEARCH TO DATE
We successfully completed a 5-year multicenter clinical trial of telehealth in 3 regions of Ontario with 680 subjects: the Community Outreach Heart Health and Risk Reduction Trial (COHRT). Motivational counseling provided to small groups via teleconference increased “readiness” to maintain heart healthy exercise and diet while reducing blood pressure among persons with cardiovascular disease or with high cardiovascular risk factors.
Building on COHRT, we completed a 3-year multicenter clinical trial of e-counseling for patients with hypertension in I-START. Among 387 subjects with hypertension, this trial demonstrated an association between e-counseling and 4-month improvement in exercise and diet, as well as decreased blood pressure and cholesterol. This trial was conducted in collaboration with the Consumer eHealth Program of the Heart and Stroke Foundation of Canada.
Reducing Risk with e-Based Support for Adherence to Lifestyle Changes in Hypertension: The REACH Trial
The main objective of the REACH trial is to assess whether preventive e-counseling (provided through a website of the Heart and Stroke Foundation of Canada) improves blood pressure and cardiovascular risk status over 12 months. REACH will also evaluate improvement in lifestyle behaviors that include diet, exercise, smoking, and adherence to prescribed medications. Finally, we will quantify the amount of e-counseling support that is required during REACH to evoke a significant reduction in blood pressure. It is hypothesized that e-Counseling (vs. Control+ usual care) will significantly improve blood pressure and lifestyle behaviours at the 12-month assessment. The findings of this trial will provide information that is critical to our understanding of how internet-based programs can help to improve blood pressure and to reduce the risk for cardiovascular disease.
Participant recruitment is closed as of March 1, 2015.
Research at Cardiac eHealth focuses on improving people’s quality of life and health through behavioral interventions delivered using the Internet, wireless and mobile devices.
Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure:
The CHF-CePPORT Trial
Chronic Heart Failure (CHF) is a growing public health issue in Canada. Counseling by multidisciplinary health care teams helps CHF patients to improve self-care behaviors (for medications, diet, exercise, smoking cessation and symptom monitoring), and this reduces the rate of death and CHF hospitalization. Without intervention, patient adherence to these behaviors is below recommended standards and quality of life among CHF patients becomes progressively compromised. A major challenge is to make self-care counseling available without overtaxing health care resources.
This 3.5-year, multicenter randomized control trial will establish and evaluate a Canadian e-platform that provides multidisciplinary e-counseling to help patients with CHF to initiate and maintain recommended self-care behaviors. We will recruit CHF patients in Toronto, Montreal, Ottawa, and Vancouver. We hypothesize that a 12-month program of e-Counseling + usual care vs. general eInfo + usual care will improve quality of life, self-care behaviors and heart health. This trial is based upon previous clinical trials in CHF, e-health and preventive lifestyle counseling by our team. It also builds upon our established collaboration with the consumer eHealth program of the Heart and Stroke Foundation of Canada. The novel contribution of this research is that it will establish an infrastructure for a pan-Canadian e-platform in preventive e-counseling for CHF. Our clinical trial will strengthen e-counseling services in order to improve the quality of life of patients with CHF.
A Qualitative Study on the Quality of Life in Heart Failure
Heart Failure (HF) is a growing public health issue in Canada. Hospital re-admission within 1-year after diagnosis is 25-40%, and the 5-year rate of HF death is 50%. Because there is no cure, quality of life has become a primary therapeutic goal for HF treatment. Although there are many ways to measure quality of life in HF, most of these do not distinguish the various dimensions of quality of life that are unique or important for each person. In addition, the available instruments fail to consider the relative importance of different dimensions to overall quality of life.
This study is a sub-study of the CHF-CePPORT trial. We will investigate how patients with HF perceive their quality of life. We will recruit and interview outpatients with HF from the Peter Munk Cardiac Centre. We will explore how patients with HF perceive their current quality of life and whether they deem it to be "good," in order to understand how they prioritize the different dimensions of quality of life. We will also investigate activities of participants that help to improve or maintain their quality of life. The findings of this study will be used to improve the next generation of the CHF-CePPORT e-counseling intervention, which is aimed to improve HF adjustment.
Quality of Life and Unmet Self-Care Information Needs of Heart Failure Patients: A Cross-Cultural Needs Assessment
Heart failure is a disease in which the heart is unable to pump oxygen-rich blood throughout the body during exercise or at rest. It is a major reason for hospital stays and death, and it is on the rise. In addition to medical treatment, patients need to carry out self-care behaviors (e.g., heart healthy diet, daily exercise, taking medication as prescribed, weight monitoring, and limiting fluid and sodium intake) to maintain heart health and to improve quality of life. Yet, many fail to follow these self-care behaviors, especially among visible ethnic minorities.
We know little about why people from the largest visible ethnic minority populations in Canada (i.e., individuals who are of Chinese, South Asian, or African-American background) have difficulties following these self-care behaviors. Before we can help these patients better adopt these self-care behaviors, we need to find out what does "living well" with heart failure mean to visible ethnic minority patients and what are the major barriers to following these self-care behaviors. We will interview heart failure patients from Chinese, South Asian, African-American, and Caucasian backgrounds about these issues. Findings from these interviews will help us develop patient-education content that is relevant to the needs of patients from these populations.
Payne AYM, Surikova J, Liu S, Ross H, Mechetiuc T, Nolan RP. Usability of an Internet-based e-counseling platform for adults with chronic heart failure. JMIR Human Factors 2015;1:e7. DOI: 10.2196/humanfactors.4125 [Click here for article]
Liu S, Hodgson C, Zbib AM, Payne AY, Nolan RP. The effectiveness of loyalty rewards to promote the use of an internet-based heart health program. Journal of Medical Internet Research 2014;16:e163. DOI: 10.2196/jmir.3458 [Click here for article]
Nolan RP, Liu S, Payne AY. E-counseling as an emerging preventive strategy for hypertension. Current Opinion in Cardiology 2014. DOI: 10.1097/HCO.0000000000000080
Nolan RP, Payne AY, Ross H, et al. An Internet-Based Counseling Intervention With Email Reminders that Promotes Self-Care in Adults With Chronic Heart Failure: Randomized Controlled Trial Protocol. JMIR Research Protocols 2014;3:e5. DOI: 10.2196/resprot.2957 [Click here for article]
Liu S, Dunford SD, Leung YW, et al. Reducing blood pressure with Internet-based interventions: a meta-analysis. The Canadian Journal of Cardiology 2013;29:613-21. DOI: 10.1016/j.cjca.2013.02.007 [Click here for article]
Nolan RP, Liu S, Feldman R, et al. Reducing risk with e-based support for adherence to lifestyle change in hypertension (REACH): protocol for a multicentred randomised controlled trial. BMJ Open 2013;3:e003547. DOI: 10.1136/bmjopen-2013-003547 [Click here for article]
Durrani S, Irvine J, Nolan RP. Psychosocial determinants of health behaviour change in an e-counseling intervention for hypertension. International Journal of Hypertension 2012;2012:191789. DOI: 10.1155/2012/191789 [Click here for article]
Nolan RP, Liu S, Shoemaker JK, et al. Therapeutic benefit of Internet-based lifestyle counselling for hypertension. The Canadian Journal of Cardiology 2012;28:390-6. DOI: 10.1016/j.cjca.2012.02.012
Nolan RP, Upshur RE, Lynn H, et al. Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial. The American Journal of Cardiology 2011;107:690-6. DOI: 10.1016/j.amjcard.2010.10.050