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. 2025 Apr 16;6(4):772-782.
doi: 10.1093/ehjdh/ztaf036. eCollection 2025 Jul.

Effect of a nurse-avatar guided discharge education smartphone application in people after acute coronary syndrome: a randomized controlled trial

Tiffany Ellis  1   2 , Sonia Cheng  1 , Robert Zecchin  2 , Karice Hyun  1   3 , Darryn Marks  4 , Ling Zhang  1 , Robyn Gallagher  1 , Robyn Clark  5 , Julie Redfern  1   4
Affiliations

Effect of a nurse-avatar guided discharge education smartphone application in people after acute coronary syndrome: a randomized controlled trial

Tiffany Ellis et al. Eur Heart J Digit Health. .

Abstract

Aims: Discharge education reduces recurrent cardiac events in people after acute coronary syndrome (ACS). This trial investigates the effectiveness of a self-administered avatar-based discharge education application (app) on knowledge and clinical outcomes among inpatients compared with usual care.

Methods and results: Single-centre randomized controlled trial of adults hospitalized with ACS who were being discharged home. The app addressed heart disease diagnosis, treatment, risk factors, symptoms, and secondary prevention. Primary outcome was heart disease knowledge at three months. Secondary outcomes were quality of life, cardiac rehabilitation attendance, hospital re-presentations, symptom beliefs, physical activity, and smoking status. Satisfaction and app costs were also evaluated. Participants (n = 84) were 86% male and aged 60 ± 11 years. Both groups had improved knowledge and quality of life. There was no difference in knowledge between groups at three months after adjusting for baseline scores [0.88 points, 95% confidence interval (CI) -5.00, 6.76]. Cardiac rehabilitation attendance was 74% and 64% in the intervention and control groups, with no differences between groups (relative risk 1.15, 95% CI 0.87, 1.51). Ninety-two per cent found the app easy to use, but only 50% used the app as anticipated. Economic analysis showed that the intervention was dominant.

Conclusion: In this sample of people with ACS with high cardiac rehabilitation attendance, the app was highly acceptable but did not improve knowledge compared with usual care. Knowledge improved in both groups and may have potential to reduce cost to the health service with the app. Further work should explore the most appropriate target audience for app-based education.

Clinical trial registration: ACTRN12622001436763.

Keywords: Acute coronary syndrome; Cardiac rehabilitation; Coronary heart disease; Digital health; Randomized controlled trial; Secondary prevention.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow of participants.
Figure 2
Figure 2
Total time spent in the app.
Figure 3
Figure 3
User satisfaction (n = 27).
See this image and copyright information in PMC

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