(P024) EFFECTIVENESS OF DIGITAL HEALTH TOOLS USED POST DISCHARGE FOR ACUTE CORONARY SYNDROME PATIENTS: A SYSTEMATIC REVIEW

Background: Post discharge, acute coronary syndrome (ACS) patients often experience symptoms that require timely assessment by medical professionals. In addition, there are challenges in medication adherence and adoption of lifestyle modifications for secondary prevention. Digital health tools (DHT) have changed the way that healthcare is delivered, and cardiac health care professionals have embraced them as promising avenues to address these issues. Despite the recent increase in their usage, the effectiveness of DHTs used in post discharge ACS care remains unclear.

METHODS AND RESULTS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and after registering in PROSPERO (CRD42024518425), we systematically searched Ovid-Medline, EMBASE, and CINAHL for randomized controlled trials (RCTs) that studied the use of DHTs post discharge for ACS patients from database inception until February 13th, 2024. Level 1 (abstract) and Level 2 (full text) screening was performed by two reviewers independently, with a third reviewer to resolve conflicts. In addition, two reviewers independently extracted the data and assessed the quality of included studies using the Cochrane Risk-of-Bias tool. The primary outcome was rehospitalization at 6 months. The secondary outcome was all-cause mortality at 6 months.

We found a total of 5261 studies (Figure 1). After deduping, 3524 studies underwent Level 1 screening, and 113 studies underwent Level 2 screening. After screening, 29 studies met the inclusion criteria (4 companion articles). A total of 5,680 individuals were included in these studies (2806 intervention, 2874 control). Study interventions included web-based platforms and mobile-based apps for providing education, data tracking, symptom monitoring, and recording medication adherence, as well as text messaging programs. The duration of intervention ranged from 1-12 months. Patients were enrolled within 90 days of ACS presentation. The mean age ranged from 52-64. Males made up 55-88% of patients. The length of study follow-up ranged from 1-14 months.

Three studies reported the primary outcome, and the OR was 0.61 (95% CI 0.35-1.07, p=0.09). Six studies reported the secondary outcome, and the OR was 0.54 (95% CI 0.27-1.08, p=0.08). A sensitivity analysis was done using per-protocol results for the primary outcome and the OR was 0.38 (95% CI 0.21-0.69, p=0.001), while the secondary outcome remained unchanged.

Conclusion: We found that digital health tools do not decrease rehospitalization or all-cause mortality at 6 months. This may be due to significant heterogeneity of the study population, protocol, outcome assessment, and length of follow up. Further research is needed.