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 .
An intervention to improve secondary prevention of coronary heart disease.
BACKGROUND Translating guidelines into clinical practice has proved to be quite difficult , even when the guidelines are well accepted and noncontroversial . Both computerized reminders and academic detailing have been effective in changing physician prescribing behavior . In this study , we sought to use these methods , mediated by clinical pharmacists , to improve adherence to the secondary prevention guidelines in hospitalized patients with myocardial infa rct ion . METHODS A r and omized , prospect i ve study was performed in which computerized alerts identifying hospitalized patients with elevated troponin I levels were routed to clinical pharmacists . The pharmacists then conducted academic detailing for physicians caring for patients with acute myocardial infa rct ion who were r and omized to the intervention group . Patients in the control group received st and ard care . The main outcome measure was the proportion of patients discharged on a regimen of aspirin , beta-blockers , angiotensin-converting enzyme inhibitors , and statins .  RESULTS The intervention had a significant impact on the proportion of patients discharged on a regimen of angiotensin-converting enzyme inhibitors  ( 328/365 [ 89.9 % ] vs 409/488 [ 83.8 % ] , intervention vs control , respectively , P = .02 ) , and statins ( 344/365 [ 94.2 % ] vs 436/488 [ 89.3 % ] , P = .02 ) . There was no statistical impact on beta-blocker ( 350/365 [ 95.9 % ] vs 448/488 [ 91.8 % ] , P = .10 ) or aspirin use ( 352/365 [ 96.4 % ] vs 471/488 [ 96.5 % ] , P = .87 ) . When all 4 classes were considered together , 305 ( 83.6 % ) of 365 patients vs 343 ( 70.3 % ) of 488 patients were discharged on a regimen of all secondary prevention medications to which they did not have a contraindication ( P<.001 ) . CONCLUSION A computerized alert with pharmacist-mediated academic detailing is an effective means to increase adherence to secondary prevention guidelines for coronary heart disease
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 .