Digital Discharge Education and Secondary Prevention of Heart Disease following Acute Coronary Syndrome

Abstract

Background: For people diagnosed with acute coronary syndrome (ACS), education on secondary prevention should commence prior to discharge from hospital, however there are many barriers to engagement and its delivery. This thesis aims to investigate if digitally delivered discharge education on secondary prevention is effective, acceptable, and feasible for improving knowledge, quality of life (QOL), and cardiovascular risk factors, and for reducing readmissions, in people following ACS.

Methods: A systematic review with meta-analyses of RCTs of secondary prevention education interventions commencing in hospital; RCT examining the effectiveness of an avatar-based discharge education smartphone application in people with ACS; and qualitative study exploring perspectives of people who declined or were ineligible to receive digitally delivered education.

Results: Discharge education on secondary prevention, compared with usual care, improves knowledge and QOL and reduces hospital readmissions in people with CHD. An RCT of the aforementioned app found it to score highly on ease of use and satisfaction, was cost-effective, but did not elicit additional improvements in knowledge compared with usual care. This lack of benefit may be explained by high rates of cardiac rehabilitation (CR) attendance and low app engagement. Digital modes of education may be more suitable for people with low disease knowledge and low intentions to attend CR. People following ACS with sound disease knowledge and intentions to attend CR, or who have competing life stressors, may benefit from non-digital modes of education.

Conclusions: This thesis provides evidence that digitally delivered discharge education on secondary prevention is acceptable and may improve outcomes. Future studies should evaluate whole models of care in which education is provided. Clinicians should tailor the mode and timing of education to the individual’s preferences, sociocultural context, and personal circumstances.