Niels Peek

Aims To assess the effects of multi-disciplinary cardiac rehabilitation (CR) on survival in the full population of patients with an acute coronary syndrome (ACS) and patients that underwent coronary revascularization and/or heart valve surgery. Methods and results Population-based cohort study in the Netherlands using insurance claims database covering ∼22% of the Dutch population (3.3 million persons). All patients with an ACS with or without ST elevation, and patients who underwent coronary revascularization and/or valve surgery in the period 2007–10 were included. Patients were categorized as having received CR when an insurance claim for CR was made within the first 180 days after the cardiac event or revascularization. The primary outcome was survival time from the inclusion date, limited to a total follow-up period of 4 years, with a minimum of 180 days. Propensity score weighting was used to control for confounding by indication. Among 35 919 patients with an ACS and/or coronary revascularization or valve surgery, 11 014 (30.7%) received CR. After propensity score weighting, the adjusted hazard ratio (HR) associated with receiving CR was 0.65 (95% CI 0.56–0.77). The largest benefit was observed for patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery (HR = 0.55, 95% CI 0.42–0.74). Conclusion In a large and representative community cohort of Dutch patients with an ACS and/or intervention, CR was associated with a substantial survival benefit up to 4 years. This survival benefit was present regardless of age, type of diagnosis, and type of intervention.

Evaluating a Web-Based Health Risk Assessment With Tailored Feedback: What Does an Expert Focus Group Yield Compared to a Web-Based End-User Survey?

Physical training has beneficial effects on exercise capacity, quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation. However, cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period. Home-based training has the potential to increase cardiac rehabilitation uptake, and was shown to be safe and effective in improving short-term exercise capacity. Long-term effects on physical fitness and activity, however, are disappointing. Therefore, we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home. In this way, we aim to improve self-management skills like self-efficacy and action planning for independent exercise and, consequently, improve long-term effectiveness with respect to physical fitness and physical activity. In addition, we aim to compare costs of this strategy with centre-based cardiac rehabilitation.

Physical inactivity, unhealthy dietary habits, smoking and high alcohol consumption are recognized risk factors for cardiovascular disease and cancer. Web-based health risk assessments with tailored feedback seem promising in promoting a healthy lifestyle. This study evaluates the effectiveness of a web-based health risk assessment with individually-tailored feedback on lifestyle behaviour, conducted in a worksite setting.

Summary: Objective: To introduce the focus theme of Methods of Information in Medicine on Intelligent Data Analysis for Knowledge Discovery, Patient Monitoring and Quality Assessment. Methods: Based on two workshops on Intelligent Data Analysis in bioMedicine (IDAMAP) held in Washington, DC, USA (2010) and Bled, Slovenia (2011), six authors were invited to write full papers for the focus theme. Each paper was throughly reviewed by anonymous referees and revised one or more times by the authors. Results: The selected papers cover four ongoing and emerging topics in Intelligent Data Analysis (IDA), being i) systems biology and metabolic pathway modelling; ii) gene expression data modelling; iii) signal processing from in-home monitoring systems; and iv) quality of care assessment. Each of these topics is discussed in detail to introduce the papers to the reader. Conclusion: The development and application of IDA methods in biomedicine is an active area of research which continues to blend with other subfields of medical informatics. As data become increasingly ubiquitous in the biomedical domain, the demand for fast, smart and flexible data analysis methods is undiminished.

Guidelines on cardiac rehabilitation (CR) state that a patient-tailored, comprehensive CR programme should be constructed for each patient based on a structured needs assessment procedure. We performed a usability evaluation with seven end-users of the MediScore CARDSS 2.0 system which implements such a procedure based on the Dutch guidelines. The analysis showed that users deviated strongly from the predefined data entry order; could not complete all subtasks for a complete needs assessment procedure, and needed more navigation actions than minimally required. We conclude that the design model of systems which implement guidelines requiring data entry should adapt to users' mental model concerning data entry to guarantee complete data collection.

Background In 2004, the Netherlands Society of Cardiology released the current guideline on cardiac rehabilitation. Given its complexity and the involvement of various healthcare disciplines, it was supplemented with a clinical algorithm, serving to facilitate its implementation in daily practice. Although the algorithm was shown to be effective for improving guideline adherence, several shortcomings and deficiencies were revealed. Based on these findings, the clinical algorithm has now been updated. This article describes the process and the changes that were made. Methods The revision consisted of three phases. First, the reliability of the measurement instruments included in the 2004 Clinical Algorithm was investigated by evaluating between-centre variations of the baseline assessment data. Second, based on the available evidence, a multidisciplinary expert advisory panel selected items needing revision and provided specific recommendations. Third, a guideline development group decided which revisions were finally included, also taking practical considerations into account. Results A total of nine items were revised: three because of new scientific insights and six because of the need for more objective measurement instruments. In all revised items, subjective assessment methods were replaced by more objective assessment tools (e.g. symptom-limited exercise instead of clinical judgement). In addition, four new key items were added: screening for anxiety/depression, stress, cardiovascular risk profile and alcohol consumption. Conclusion Based on previously determined shortcomings, the Clinical Algorithm for Cardiac Rehabilitation was thoroughly revised mainly by incorporating more objective assessment methods and by adding several new key areas.

Background: Primary prevention programs at the worksite can improve employee health and reduce the burden of cardiovascular disease. Programs that include a web-based health risk assessment (HRA) with tailored feedback hold the advantage of simultaneously increasing awareness of risk and enhancing initiation of health-behaviour change. In this study we evaluated initial health-behaviour change among employees who voluntarily participated in such a HRA program. Methods: We conducted a questionnaire survey among 2289 employees who voluntarily participated in a HRA program at seven Dutch worksites between 2007 and 2009. The HRA included a web-based questionnaire, biometric measurements, laboratory evaluation, and tailored feedback. The survey questionnaire assessed initial self-reported health-behaviour change and satisfaction with the web-based HRA, and was e-mailed four weeks after employees completed the HRA. Results: Response was received from 638 (28%) employees. Of all, 86% rated the program as positive, 74% recommended it to others, and 58% reported to have initiated overall health-behaviour change. Compared with employees at low CVD risk, those at high risk more often reported to have increased physical activity (OR 3.36, 95% CI 1.52-7.45). Obese employees more frequently reported to have increased physical activity (OR 3.35, 95% CI 1.72-6.54) and improved diet (OR 3.38, 95% CI 1.50-7.60). Being satisfied with the HRA program in general was associated with more frequent self-reported initiation of overall health-behaviour change (OR 2.77, 95% CI 1.73-4.44), increased physical activity (OR 1.89, 95% CI 1.06-3.39), and improved diet (OR 2.89, 95% CI 1.61-5.17). Conclusions: More than half of the employees who voluntarily participated in a web-based HRA with tailored feedback, reported to have initiated health-behaviour change. Self-reported initiation of health-behaviour change was more frequent among those at high CVD risk and BMI levels. In general employees reported to be satisfied with the HRA, which was also positively associated with initiation of health-behaviour change. These findings indicate that among voluntary participating employees a web-based HRA with tailored feedback may motivate those in greatest need of health-behaviour change and may be a valuable component of workplace health promotion programs.