The efficacy of secondary prevention programs with remote support in ischemic heart disease patients with abdominal obesity

Abstract

Background. Longterm secondary preventive programs in ischemic heart disease (IHD) are of highest efficacy but numerous organizational problems often compromise their implementation. Contemporary remote technologies have a potential to overcome these barriers. Aim: to assess the impact of two preventive counselling programs with subsequent remote support in IHD patients with concomitant obesity. Methods. We conducted a prospective randomized parallelgroup study on 120 stable IHD patients with concomitant obesity (age 40 to 65 years) hospitalized for elective coronary revascularization. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, patients of groups 1 and 2 received a singlesession comprehensive counselling with focus on diet followed by remote counselling by phone (group 1) or via text messages (group 2). Remote counselling was delivered weekly (months 1–3) and then monthly (months 4–6). Patients of group 3 (control) received only standard advice from their attending physicians. Patients were followed for 12 months with assessment of dynamics of adiposity measures, selfreported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and Creactive protein (CRP) levels, as well as with registration of clinical events. Results: At 1 year of followup, patients of both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m2 in group 1 and by 1.53±0.18 kg/m2 in group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the heightnormalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all p values <0.01 vs corresponding changes in the control group 3). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in group 1 and from 80% to 10% in group 2 (both pvalues <0.01 vs control). In group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values <0.01 vs control. In group 2 systolic BP dropped by only 11.95±2.50 mmHg (nonsignificant) and diastolic BP by 6.33±1.52 mmHg (р<0.05 vs control). The proportion of smokers went down from 30% to 5% in group 1 and from 22.5% to 0% in group 2 (both p values <0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in group 1 and by 0.48±0.25 mmol/L in group 2 (both p<0.01 vs control,), but there were no meaningful improvements in blood lipids or CRP. Conclusion: Longterm (6 months) secondary prevention programs incorporating technologies of remote support resulted in sustained positive dynamics of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).