Coronary artery disease (CAD) represents as a significant global cause of mortality, particularly prevalent in India, where it constitutes a leading cause of morbidity and mortality. Notably, its prevalence is higher in urban areas as compared to rural regions.¹ Despite efforts in education and knowledge dissemination, approximately 50% of all cardiovascular disease (CVD) cases stem from lifestyle-related risk factors.

Digital technology emerges as a promising solution, offering an alternative to conventional cardiac rehabilitation.² It can facilitate improvements in medication compliance, enable regular follow-ups, aid in identifying risk factors, enable early diagnosis, assist in treatment planning, and enhance treatment adherence. Moreover, its implementation holds the potential to alleviate financial burdens and enhance the overall quality of life.³ These technologies empower patients to take charge of their health, enabling them to make informed decisions and providing them with the means to monitor and manage their healthcare effectively.⁴

Time constraints, patient overpopulation, and complex guidelines necessitate alternative solutions for real-time patient monitoring.⁵ The integration of rapidly evolving digital technology offers an effective solution to address these challenges.⁶ There is a growing need for additional research due to the sparse data available to harness the full potential of digital technology.⁷ It is also important to maintain privacy and confidentiality when implementing digital interventions into clinical practice.⁸

This study aims to evaluate the impact of digital technology on medication adherence, the modification of risk factors, and clinical outcomes (Central Illustration), including: a) Fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), cardiovascular mortality, and all-cause mortality and b) Non-fatal MI and repeat hospitalizations for both cardiac and non-cardiac causes.

This work will be a two-year prospective, randomized study of patients admitted with acute coronary syndrome (ACS), including ST elevation myocardial infarction (STEMI), Non ST elevation myocardial infarction (NSTEMI), and Unstable angina. The sample size powered for the study will be 522 patients, who will be randomized in a 1:1 ratio to either the digital intervention group or the control non-digital intervention group. Informed consent will be obtained from all patients. They will then be randomly assigned to one of two groups: the Digital App Group or the Control Group. Participants will be randomly assigned to case or control groups based on a manual randomization process. Parameters, such as gender, age group, and diagnosis, will be coded, and a unique number will be assigned to each category. Patients will then be randomized into the case or control group according to this unique number, ensuring that the distribution was balanced across these parameters. Both groups will receive standard care before being randomized in the study.

Baseline demographic and clinical data, including age, gender, address, contact information, education, height, weight, and previous medical history, will be recorded. Additionally, risk factors, such as diabetes, hypertension, dyslipidemia, prior history of Ischemic heart disease, prior family history of CAD, alcohol consumption, smoking, and obesity will be documented, and any symptoms that may appear, will be duly documented. Electrocardiogram, Echocardiogram, and Troponin T blood levels will be taken for all patients. Laboratory investigations, including fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1C, hemoglobin (Hb), serum creatinine, and lipid profile will be measured for all patients (Figure 1 & 2).

Figure 1

A coronary angiography will be performed at the discretion of the treating physician based on the clinical condition of the patient and if the patient agrees to the procedure. The therapeutic approach and outcome will be updated via digital technology for the Digital App Group (Supplemental Figure 1). Conversely, for the Control Group, all data will be collected at baseline without the use of the app.

The application will be accessible in both regional (Kannada) and English languages. In the digital intervention group, patients and their relatives will receive training in the hospital on how to update data and reports, as well as how to access health education materials (Figure 3) related to cardiovascular health. A chat option will be available within the app to address any concerns or queries regarding health status or minor symptoms. Additionally, users will be informed that, in case of emergency or if warning signs of symptoms arise, they should seek medical attention promptly, as the app is not a replacement for a doctor.

Figure 3

Both groups will undergo clinical follow-up at recommended intervals. Telephone follow-up will occur mandatorily every three months to monitor any adverse events in both groups. At the end of the study, a final clinical visit will be conducted at 12 months for both groups.

Patients will be informed about the study, and written informed consent will be obtained prior to any study procedures. The study has been approved by the Institutional Ethics Committee of Sri Jayadeva Institute of Cardiovascular Sciences, Mysore (SJICS&R/IEC07/2023/01), and the Institutional Ethics Committee of JSS Medical College (JSSMC/IEC/27102023/06 NCT/2023). Key findings will be published in leading academic journals and will be presented at conferences. Additionally, a thesis will be prepared.

This study aims to evaluate the impact of digital technology on medication compliance, the modification of risk factors, and clinical outcomes, including:

The recruitment stage has been concluded, with a total of 522 patients diagnosed with ACS, equally randomized into two groups: 261 patients in the digital group and 261 patients in the control group. Data collection is scheduled to be concluded by May 2025.

The present study aims to assess the effectiveness of digital technology intervention in enhancing regular follow-up, remote monitoring, medication compliance, the modification of risk factors, reductions in recurrent cardiovascular events, and improving disease self-management and health outcomes among patients diagnosed with ACS.⁹

Digital technology has the potential create awareness about cardiovascular health.¹⁰ These technologies, including web applications (cloud computing application) can disseminate educational materials and educate the individual about the effect of risk factors,¹¹ such as diabetes, cholesterol, lack of physical activity, smoking, excessive alcohol consumption, and unhealthy dietary habits. It underscores the importance of the consumption of fruits and vegetables, as well as highlights the importance of physical activity, such as walking, jogging, and swimming. Additionally, it promotes healthy behavioral habits.³

Digital technology interventions for cardiac rehabilitation have demonstrated comparable impacts on health outcomes to conventional clinic-based programs,¹² particularly in reducing recurrent cardiovascular events and improving one’s quality of life. These interventions aim to bridge the gap between hospital-based care and patient home care, enhancing the quality of care and reducing disparities associated with geographic and financial constraints.^5,13

This digital technology was quite useful during the COVID-19 pandemic when patients found it extremely difficult to approach hospitals¹⁴ and seek medical care due to lockdowns and the stigma attached to healthcare facilities⁴.The burden of CVD is rapidly increasing in developing countries. However, access to cardiovascular rehabilitation and secondary prevention continues to be limited in these regions.⁶ Digital technology offers low-cost¹⁵ and easily accessible models to bridge the gap between health-based care and home care.