Digital Health Interventions in Patient Management Following Acute Coronary Syndrome: A Meta-Analysis of the Literature

Abstract

Objective: Acute coronary syndrome patients should be closely followed-up to maintain optimal adherence to medical treatments and to reduce adverse events. Digital health interventions might provide improved outcomes for patient care by providing closer follow-up, compared to standard care. Thus, in this meta-analysis, we aimed to evaluate the effect of digital health interventions on follow-up in acute coronary syndrome patients. Methods: We searched medical databases to obtain all relevant studies comparing digital health interventions with standard care in acute coronary syndrome patients. After reviewing all eligible studies, a meta-analysis was conducted with the remaining 11 randomized controlled studies and 2 non-randomized controlled studies. A modified Jadad scale and Newcastle-Ottawa scale were used to assess the quality of the publications for randomized controlled studies and non-randomized controlled studies, respectively. Results: This meta-analysis consisted of 7657 patients. The all-cause mortality rate was 49% lower in the digital health intervention cases, compared to those who received standard care [relative risk (RR) = 0.51 (0.37; 0.70), P < .01]. There was a significant decrease in systolic blood pressure in the digital health interventions group, compared to the standard care group [mean difference = -5.28 (-9.47; -1.08), P = .01]. The rate of nonadherence to anti-aggregant drugs was 69% lower in the digital health interventions than in the standard care group [RR = 0.31 (0.20; 0.46), P < .01]. Also, nonadherence rates for statin and beta-blockers were lower in the digital health interventions group. The risk of rehospitalization was observed to be 55% less in the digital health interventions patients, compared to the standard care group [RR = 0.45 (0.30; 0.67), P < .01]. Conclusion: Digital health interventions can be effective in follow-up for secondary prevention in acute coronary syndrome patients.

Assessment of Medication Adherence Using Pharmacy Data Before and After Percutaneous Coronary Intervention

“…There is increasing evidence of the impact of digital health interventions on adherence and outcomes for patients with cardiovascular disease. 28 , 29 Future studies may test integrated solutions using data obtained from pharmacy systems, personal devices, and patient-reported symptoms.…”

“…Our study has several limitations. There are many potential ways to assess fill-based adherence; our method may underestimate non-adherence relative to other algorithms, 28 identifying a relatively small high-risk group (20% of patients). Specifically, for patients taking multiple medications we assigned the highest individual medication PDC as the overall patient PDC, under the assumption that this demonstrates the best adherence the patient has achieved.…”

Cardiovascular protective effect of sodium-glucose cotransporter 2 inhibitors on patients with acute coronary syndrome and type 2 diabetes mellitus: a retrospective study

“…In addition to developing new treatment measures, digital health interventions (DHIs) have shown promising prospects in the management of CAD [ 33 ], especially during the coronavirus disease pandemic when remote healthcare services have been widely used. DHIs can provide closer follow-up and effective secondary prevention in patients with ACS through various means, such as mobile text messages, voice messages, video clips, telephone calls, video conferences, mobile applications, and smartwatches.…”

Digital Health Secondary Prevention Using Co-Design Procedures: Focus Group Study With Health Care Providers and Patients With Myocardial Infarction

“…This risk reduction is greater than that of other common preventive measures, such as statins, aspirin, and blood pressure reductions with β-blockers [12]. Ultimately, the all-cause mortality rate is reduced by 49% when comparing those who used digital health secondary preventions compared with standard care, showing the utility of digital health in cardiovascular disease secondary prevention [13].…”

“…Digital health has been successfully used to reduce cardiovascular disease risk factors and outcomes, with secondary preventions leading to a 40% reduction in the relative risk of cardiovascular disease outcomes and reduced morbidity and mortality [12]. Specifically, digital health secondary preventions led to significant reductions in systolic blood pressure, reduced antiaggregant medication nonadherence by 69%, and reduced rehospitalization by 55% compared with standard care [13]. This risk reduction is greater than that of other common preventive measures, such as statins, aspirin, and blood pressure reductions with β-blockers [12].…”