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Web Sites as New Tools for
Cardiovascular Disease Prevention
and Health Promotion

Castello, Cristina; Li Greci, Ennio; Angeli, Stefano

Gardacuore Association, Verona, Italy

SUMMARY
Internet has become a major tool for providing medical information and promoting health education.
www.gardacuore.it is a new web site, developed by the non-profit association Gardacuore to prevent cardiovascular diseases and promote cardiovascular health through medical information and health education to professionals and patients.
The website consists of a general cardiovascular resource, a weekly review of articles on cardiovascular prevention, a physician-specific area and area devoted to the patients, providing healthcare material and expert counselling.
The website supports locally some global initiatives on cardiovascular prevention, as the World Heart Day and the No-smoking Day.
It conforms to ethical standards and principles of the Health on the Net Foundation Code of Conduct. Medical and health advice is given by qualified cardiologists, the information provided is designed to support and not replace the patient / physician relationship, information is supported by clear references to source data, contact addresses for visitors seeking further information or support is provided, support for the Web site is clearly identified, including the identities of commercial and non-commercial organisations that contribute funding, services or material for the site.
The website was published on January 2001 and up to now over 2.000 different visitors have visited the site, over 70% of visitors in at least 2 different days.
Nearly 45% of visitors are patients asking for advice on personal health problems and requesting booklets and information on cardiovascular risk factors. Awareness on specific cardiovascular risks (smoking, high cholesterol, physical activity) increased by 40% in patient/site visitor after visiting the website.
It is concluded that websites are potential tool for cardiovascular prevention. However, the quality of the content and potential conflicts of interest must be addressed properly.

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OBJECTIVES
   To verify if websites may contribute to the prevention of cardiovascular diseases (CVD); to describe a new website devoted to prevention of CVD, with particular emphasis on the ethical issues related to spreading of medical information through the Internet.

BACKGROUND
   The Internet has become a major tool for providing medical information and promoting health education. It has permitted physicians, other health care professionals, patients, and other consumers to quickly access medical information in unprecedented volume. Such access has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment (with sometimes questionable patient understanding and adherence to recommendations) to that of shared decision making between patient and physician.

   However, several substantial barriers remain before this relationship can be realized. These barriers
include equitable access to information, imbalance between patient health literacy and the information provided, extreme variability in the quality of the content, potential for commercial interests to influence content, and uncertain preservation of personal privacy.

MATERIAL AND METHODS
   Several websites have been developed to provide medical doctors, patients and customers medical information and medical services on prevention of CVD diseases.

   A research at June 30,2001 on Altavista web engine using the key words "cardiovascular" AND "prevention" has identified a total of 32421 potential sites. After a screening of different sites, 258 websites providing substantial information on CVD prevention have been identified.

   www.gardacuore.it is a new web site, developed by the non-profit association Gardacuore to prevent cardiovascular diseases and promote cardiovascular health through medical information and health education to professionals and patients.

   The Gardacuore website consists of a general cardiovascular resource, a weekly review of articles on cardiovascular prevention, a physician-specific area and a patients- devoted area.

   - The General Cardiovascular Resource area provides information on

   - The weekly review provides the bibliographic reference and often the most informative section of the abstract (some translated into Italian) of articles on CVD prevention published in the previous week on 5 biomedical journals (New England Journal of Medicine, Journal of American Medical Association, British Medical Journal, Archives of Internal Medicine, Annals of Internal Medicines) and 4 cardiologic journals (Circulation, Journal of American College of Cardiology, European Heart Journal, Italian Heart Journal).

   - The Physician Cardiovascular Resource area provides information on sensitive topics and treatment options for different cardiovascular risk factors and conditions:

• genetics;
• information on prescription of reimbursed drugs to treat hypercholesterolemia (note 13 of the Italian drug formulary), including a cardiovascular risk calculator;
• treatment of hypercholesterolemia;
• treatment of nicotine dependency;
• treatment of hypertension;
• treatment of obesity;
• treatment of atherosclerosis;
• secondary prevention;
• drugs in clinical development for CVD prevention.

   - The patient section provides both healthcare documents, brochures and leaflets on treatment of major cardiovascular risk factors and an "Ask the expert" section, providing professional counselling on CVD prevention. Their assessment of the usefulness of information provided by the site and the change of awareness on different cardiovascular risk factors is requested at each contact

   Most section are interactive, allowing users to provide additional information (if available), to submit proposals to be sent on behalf of Gardacuore to national and regional decision makers. Accreditation as a content provider for e-Learning programs on CVD prevention for medical doctors, nurses and other health operators have bee requested: the first course will be on-line in September 2001 for the World Heart Day.

   The Gardacuore website supports locally some global initiatives on CVD prevention, as the World Heart Day and the No-Smoking Day.

   Gardacuore website conforms to ethical standards and principles of the Health on the Net Foundation Code of Conduct (Application for HONcode certification requested on May 13, 2001) as far as:

* authority: medical or health advice provided and hosted on Gardacuore site is only be given by medically trained and qualified professionals
* complementarity: the information provided on Gardacuore site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.
* confidentiality: confidentiality of data relating to individual patients and visitors to Gardacuore Web site, including their identity, is respected by the Web site. The Web site owners undertake to honour or exceed the legal requirements of medical/health information privacy that apply in Italy.
* attribution: Where appropriate, information contained on Gardacuore site is supported by clear references to source data and, where possible, have specific HTML links to that data. The date when a clinical page was last modified is clearly displayed at the bottom of the page.
* justifiability: Any claims relating to the benefits/performance of a specific treatment, commercial product or service is supported by appropriate, balanced evidence;
* transparency of authorship: the designers of Gardacuore Web site seek to provide information in the clearest possible manner and provide contact addresses for visitors that seek further information or support. The Webmaster displays his E-mail address clearly throughout the Gardacuore Web site.
* transparency of sponsorship: support for Gardacuore Web site is clearly identified, including the identities of commercial and non-commercial organisations that have contributed funding, services or material for the site.
* honesty in advertising & editorial policy: advertising is not a source of funding

   Major criteria used to assess websites are (a) quality of graphics, (b) easiness of access to information and navigability, (c) interactivity, (d) content. For the development of the first release of www.gardacuore.it only the last two have been considered.

RESULTS AND DISCUSSION
   After a pilot assessment period of 4 months (September - December 2000) with a restricted number of users, the website was published on January 2001 and up to now over 2.544 different visitors have visited the site, 71% of visitors in at least 2 different days.

   Most visited pages are (as percentage of total views) healthcare plans (6.02), obesity (12.48), weekly review on medical journal (4.21), smoke (6.08) and alimentation (5.64). Figure 1

   Nearly 45% of visitors are patients asking for advice on personal health problems and requesting booklets and information on cardiovascular risk factors. Awareness on specific cardiovascular risks (smoking, high cholesterol, physical activity) increased by 40% in patient/site visitor after visiting the website.

CONCLUSION
   It is concluded that websites are potential tool for cardiovascular prevention and that www.gardacuore.it has contributed to prove this principles. Quality of the content and potential conflicts of interest are major areas of potential concern and must be addressed and followed up properly.

   Based on these results, the second version of www.gardacuore.it will be released in 4 Quarter 2001.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
apacher@satlink.com

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