Similarly , there was no clear evidence of effect for cardiovascular risk factors , although again the number of studies reporting these was small .
There was some evidence for beneficial effects on HRQOL , dietary outcomes , and physical activity , although firm conclusions can not yet be made .
The effects on healthcare utilisation and cost-effectiveness are also inconclusive , and trials are yet to measure the impact of  Internet interventions on compliance with medication .
BACKGROUND The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease ( CHD ) .
OBJECTIVES To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD .
Effect of Adding a Values Clarification Exercise to a Decision Aid on Heart Disease Prevention: A Randomized Trial
Background . Experts have called for the inclusion of values clarification ( VC ) exercises in decision aids ( DAs ) as a means of improving their effectiveness , but little research has examined the effects of such exercises . Objective . To determine whether adding a VC exercise to a DA on heart disease prevention improves decision-making outcomes . Design . R and omized trial . Setting . UNC Decision Support Laboratory . Patients . Adults ages 40 to 80 with no history of cardiovascular disease . Intervention . A Web-based heart disease prevention DA with or without a VC exercise . Measurements . Pre- and postintervention decisional conflict and intent to reduce coronary heart disease ( CHD ) risk and postintervention self-efficacy and perceived values concordance . Results . The authors enrolled 137 participants ( 62 in DA ; 75 in DA + VC with moderate decisional conflict ( DA 2.4 ; DA + VC 2.5 ) and no baseline differences among groups . After the interventions , they found no clinical ly or statistically significant differences between groups in decisional conflict ( DA 1.8 ; DA + VC 1.9 ; absolute difference VC — DA 0.1 , 95 % confidence interval [ CI ] : —0.1 to 0.3 ) , intent to reduce CHD risk ( DA 98 % ; DA + VC 100 % ; absolute difference VC — DA : 2 % , 95 % CI : —0.02 % to 5 % ) , perceived values concordance ( DA 95 % ; DA + VC 92 % ; absolute difference VC — DA —3 % , 95 % CI : —11 % to + 5 % ) , or self-efficacy for risk reduction ( DA 97 % ; DA + VC 92 % ; absolute difference VC — DA —5 % , 95 % CI : —13 % to + 3 % ) . However , DA + VC tended to change some decisions about risk reduction strategies . Limitations . Use of a hypothetical scenario ; ceiling effects for some outcomes . Conclusions . Adding a VC intervention to a DA did not further improve decision-making outcomes in a population of highly educated and motivated adults responding to scenario-based questions . Work is needed to determine the effects of VC on more diverse population s and more distal outcomes
Similarly , there was no clear evidence of effect for cardiovascular risk factors , although again the number of studies reporting these was small .
There was some evidence for beneficial effects on HRQOL , dietary outcomes , and physical activity , although firm conclusions can not yet be made .
The effects on healthcare utilisation and cost-effectiveness are also inconclusive , and trials are yet to measure the impact of  Internet interventions on compliance with medication .
BACKGROUND The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease ( CHD ) .
OBJECTIVES To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD .