Internet-based behavioral change and psychosocial care for patients with cardiovascular disease: A review of cardiac disease-specific applications Emily A. Kuhl, MA, a Samuel F. Sears, PhD, a and Jamie B. Conti, MD b BACKGROUND: Web-based interventions (WBIs) seem to be an efficacious method of addressing behavioral and psychosocial maladjustment among patients with chronic illness (eg, diabetes), behav- ioral concerns (eg, smoking cessation), and psychologic maladjustment (eg, panic disorder). Cardiology seems particularly well suited to the application of WBIs given its strong association with behavioral (eg, lifestyle) and cognitive (eg, stress and coping) factors. To date, few studies have been published that explore the use of WBIs on psychosocial and quality of life variables among populations with cardiac disease. OBJECTIVE: The purpose of this study is to review the use of WBIs in patients with cardiovascular disease to date, and to provide recommendations as to how future WBIs can be developed specifically to meet the needs of different populations with heart disease (eg, recipients of implantable cardioverter defibrillators, patients with congestive heart failure, and patients with congenital heart disease). CONCLUSIONS: We conclude that, although limitations exist, WBIs are a reasonable modus of improving patient outcomes. (Heart Lung® 2006;35:374 –382.) A pproximately 64 million Americans have been diagnosed with one or more types of cardio- vascular disease. 1 Interventions that address diagnosed conditions, as well as those that prevent disease by reducing risk factors, provide compre- hensive care, and improve both physical and psy- chologic outcomes. Web-based interventions (WBIs) are an increasingly popular method of deliv- ering health services and are applicable to the care of the patient with cardiovascular disease. WBIs have the potential to change risk factor profiles in patients with cardiovascular disease. 2-4 For example, online smoking cessation programs, such as QuitNet.org, have been successful by pro- viding education, social support, and quit-plan de- velopment, 2,5,6 although these programs have yet to be fully validated. 7 In regard to nutrition education, computerized programs that offer patients individ- ualized plans for their specific needs may be more economical and time-efficient than traditional ones (eg, pamphlets and brochures). 8 Although some on- line programs have been successful in helping per- sons achieve weight loss, 3,9 results regarding their effectiveness are mixed, indicating that Internet in- terventions for obesity may better serve as a sup- plement to, rather than a substitute for, more con- ventional weight-loss programs. 10 Similarly, physical-activity WBIs have demonstrated equal utility, and in some cases suboptimal utility, when compared with in-person interventions. 11,12 For patients already diagnosed with cardiovascu- lar disease, WBIs have been shown to increase pa- tient knowledge, independence, self-management, compliance, and quality of life. 13,14 However, the number of Web-based studies to improve psycho- social outcomes in patients with cardiac disease is small. Therefore, more research is needed to refine interventions to the particular needs of subpopula- From the a Department of Clinical and Health Psychology and b Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida. Reprint requests: Emily A. Kuhl, MA, University of Florida, De- partment of Clinical and Health Psychology, Box 100165 UF Health Science Center, Gainesville, FL 32610. 0147-9563/$ – see front matter Copyright © 2006 by Mosby, Inc. doi:10.1016/j.hrtlng.2006.02.004 374 www.heartandlung.org NOVEMBER/DECEMBER 2006 HEART & LUNG