Cardiovascular risk factors, exercise capacity and health literacy in patients with chronic ischaemic heart disease and type 2 diabetes mellitus in Germany: Baseline characteristics of the Lifestyle Intervention in Chronic Ischaemic Heart Disease and Type 2 Diabetes study.

BACKGROUND: Lifestyle interventions are a cornerstone in the treatment of chronic ischaemic heart disease (CIHD) and type 2 diabetes mellitus (T2DM). This study aimed at identifying differences in clinical characteristics between categories of the common lifestyle intervention targets BMI, exercise capacity (peak V̇O2) and health literacy (HL). METHODS: Cross-sectional baseline characteristics of patients enrolled in the LeIKD trial (Clinicaltrials.gov NCT03835923) are presented in total, grouped by BMI, %-predicted peak V̇O2 and HL (HLS-EU-Q16), and compared to other clinical trials with similar populations. RESULTS: Among 499 patients (68.3±7.7 years; 16.2% female; HbA1c, 6.9±0.9%), baseline characteristics were similar to other trials and revealed insufficient treatment of several risk factors (LDL-C 92±34 mg/dl; BMI, 30.1±4.8 kg/m2; 69.6% with peak V̇O2<90% predicted). Patients with lower peak V̇O2 showed significantly higher (p < 0.05) CIHD and T2DM disease severity (HbA1c, CIHD symptoms, coronary artery bypass graft). Obese patients had a significantly higher prevalence of hypertension and higher triglyceride levels, whereas in patients with low HL both quality of life components (physical, mental) were significantly reduced. CONCLUSIONS: In patients with CIHD and T2DM, peak V̇O2, BMI and HL are important indicators of disease severity, risk factor burden and quality of life, which reinforces the relevance of lifestyle interventions.

Telemedicine acceptance and efficacy in the context of preventive cardiology interventions: A systematic review.

Introduction: Telemedicine is being used in an increasing number of healthy lifestyle intervention studies in preventive cardiology. However, the optimal telemedicine-based approach for patients with cardiovascular disease remains unclear. Therefore, the aim of this systematic review is to identify which design features are associated with the acceptance and efficacy of telemedicine in this specific patient population. Methods: The databases PubMed/MEDLINE, Embase and the Web of Science Core Collection were searched from 5 October 2010 to 5 October 2020. This systematic review only included randomized controlled or quasi-randomized controlled trials with a comparator to a telemedicine-based intervention group and a designated measure of adherence. We adopted a narrative synthesis approach to define telemedical design features, which were clustered into three main categories (social, exercise related and barrier removal) and compared to adherence (graded as good, medium and bad) and primary outcomes (significant improvement, no significant change). Results: We screened a total of 865 records, of which 14 were included in this review, containing 13 identified design features. In 8 studies (57.1%), adherence was graded as good (4 studies medium, 2 studies bad). A positive primary outcome occurred in 10 (71.4%) studies. Personal contact showed the most pronounced (while not statistically significant) positive association with adherence and study outcomes. Conclusion: Given the remote nature of telemedical lifestyle intervention studies, including recurring personal contact in the intervention seems to be a key factor in ensuring that adherence levels remain comparable to those seen in centre-based interventions.