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 .
The TeleGuard trial of additional telemedicine care in CAD patients. 1 Utilization of the system
Summary Patients with established coronary artery disease ( CAD ) were recruited in 11 hospitals and r and omized to an intervention ( telemedicine system ; n = 752 ) or a control group ( usual medical care ; n = 748 ) . On the day before discharge , patients in the intervention group were equipped with a 12-lead event recorder and trained to use the device . Whenever they had symptoms , they could contact the call centre , transmit an ECG ( without redialling ) and consult a physician . During a 12-month study , 171 patients ( 23 % ) in the intervention group contacted the call centre , a total of 269 times . The main reasons for calling were chest pain and radiating pain . Pathological changes were seen in 24 % of the transmitted ECGs . Only 23 % of the calls were made in the first hour after onset of symptoms and a further 12 % in the subsequent hour , suggesting that patients should be encouraged to use ECG transmission at an earlier stage . At follow-up , 157 patients ( 21 % ) had had at least one recurrent cardiac event ( myocardial infa rct ion , cardiac hospital stay , re-vascularization ) . The proportion was significantly higher in telemedicine users ( 35 % ) than in non-users ( 17 % ) , P < 0.001 . Regardless of utilization , the majority of the intervention patients considered that the telemedicine system was helpful ( users = 93 % , non-users = 89 % ; P = 0.095 )
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 .