Effects of a Nurse-Avatar Guided Discharge Education Smartphone Application in People After Acute Coronary Syndrome: A Randomised Controlled Trial

Aim:
To investigate the effects of an avatar-based discharge education application (app) on knowledge among inpatients admitted with acute coronary syndrome (ACS) compared to usual care alone.

Method:
Single centre randomised controlled trial of people hospitalised with ACS who were being discharged home and had a device capable of downloading the app. Intervention participants downloaded the ‘Six Steps to Cardiac Recovery’ app and were encouraged to complete six interactive educational modules covering heart disease diagnosis, treatment, risk factors, symptom management and secondary prevention. The primary outcome was heart disease knowledge (Coronary Artery Disease Education Questionnaire-II) at three months. Secondary outcomes were quality of life (QOL), cardiac rehabilitation (CR) attendance, app engagement and satisfaction.

Results:
Eighty-four participants, 86% male, mean age 60 years (SD 11) were randomised. At three months, the intervention group had increased knowledge and QOL but there were no significant between-group differences for the primary or secondary outcomes after adjusting for baseline values (Table). CR attendance was high; 74% of intervention participants and 64% of control participants attended (RR 1.2 (0.9, 1.5)). Using Google Analytics, participants spent 23 minutes (IQR 4–38) using the app. App satisfaction was high (89% found the app useful, 92% easy to use). Trialling app-based education in people following ACS who do not attend CR should be explored in future studies.

Conclusion:
In this trial, CR was well attended and using an avatar to deliver education via an app did not significantly improve outcomes, however patient satisfaction was high.