Abstract Body (Do not enter title and authors here):
Background: The role of digital health interventions (DHI) in addition to usual care (UC) in patients discharged after an acute coronary syndrome (ACS) remains uncertain.
Hypothesis: DHI improves medication adherence, and systolic blood pressure (BP) control and reduces mortality in patients after an ACS.
Purpose: To ascertain the efficacy of adding DHI to UC in patients discharged after an ACS through a systematic review and meta-analysis.
Methods: We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing DHI plus UC versus UC alone in patients discharged after an ACS. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous outcomes, respectively. Our outcomes of interest were medication adherence (as per the studies' definitions), all-cause mortality, and systolic BP. Statistical analyses were performed using R software version 4.4.0.
Results: We included 22 RCTs comprising 20,587 patients, of whom 14,079 (68.4%) were randomized to DHI + UC. The mean age was 59.5 years and 58.5% were male. About 15% had diabetes mellitus at baseline while 54% had hypertension. In the pooled analysis, DHI plus UC significantly increased medication adherence (RR 1.06; 95% CI 1.01 to 1.13; p=0.03; Fig. 1) and reduced systolic BP (MD -3.16 mmHg; 95% CI -5.53 to -0.79; p<0.01; Figure 2A) compared with UC alone. There was no significant difference between groups in terms of all-cause mortality (RR 0.87; 95% CI 0.52 to 1.44; p=0.58; Figure 2B).
Conclusion: In this meta-analysis of RCTs among patients discharged after an ACS, UC with DHI significantly improved medication adherence and lowered systolic BP relative to UC alone, without significantly affecting mortality.