Recovery and secondary prevention challenges in people with acute coronary syndrome: digital and peer solution

Abstract

Self-management of coronary heart disease (CHD) is an important aspect of acute coronary syndrome (ACS) recovery, however, may be hindered by cognitive impairment, psychosocial impacts, and a lack of available support after discharge. The impact of cognitive challenges after ACS, especially in spontaneous coronary artery dissection (SCAD), is not well understood. Peer support and health information websites may offer valuable solutions to these issues. The aim of this thesis was to explore the nature and experiences of cognitive challenges, the online information available for SCAD survivors, and the potential effectiveness of peer support, during and after ACS admission. Cognitive challenges were evaluated using: 1) an observational descriptive study of ACS inpatients screened for mild cognitive impairment, 2) seven thematically analysed focus groups of SCAD survivors exploring experiences of brain fog. Potential solutions for recovery and secondary prevention challenges were evaluated using: 1) appraisal of the websites publicly available for SCAD survivors, 2) systematic review and meta-analysis of coronary heart disease peer support interventions, 3) semi-structured focus groups and interviews with consumers and clinicians, identifying peer support benefits and priorities for future interventions. Mild cognitive impairment was identified in 53% of ACS inpatients, with single and older patients at highest risk. Patients with SCAD experienced brain fog, including memory, concentration and judgement issues. Websites for SCAD survivors (n=50) varied from average to poor in content, quality, suitability, readability and interactivity. Meta-analysis (n=16) indicated peer support interventions improved self-efficacy, self-management behaviour, and reduced readmissions. Priorities for peer support included awareness, flexibility, resources, autonomy, safeguarding, and simple interfaces.