Post-discharge digital self-management for acute coronary syndrome patients: A scenario-based design and implementation

We used a scenario-based design approach [6] to model the desired functionalities and user experience. The scenario was developed using qualitative input from a patient panel, nurse practitioners, cardiologists, the coronary care unit, and rehabilitation nurses. Functional requirements were derived from four recurring themes: patient confusion, low self-efficacy, care discontinuity, and lack of remote insight into patient recovery. Fundamentally, the new design also incorporates a new outpatient follow-up scheme, omitting the regular 2‑week lab value controls and the scheduled 4‑week outpatient ACS clinic visit.

“Walt,” a 75-year-old male STEMI patient who underwent a primary percutaneous coronary intervention served as the user archetype. After discharge, the ACS app needed to improve patients’ like “Walt” insight into their condition even after treatment. This new modality should incorporate items to help patients realize the impact of their risk factors and how behavioral changes play a role. His digital journey from hospitalization through disease-education, rehabilitation and home-based self-management was scripted to illustrate critical system interactions. Features and workflows were prototyped at high fidelity and fitted into the new innovative IT-modality including a messenger service for educational push messages. At onboarding, the CCU nurse installs the ACS app on the patient’s own smartphone and guides the patient and family through the app’s components, offering continuity and clarity [5]. Coaching interventions include activity challenges and motivational messaging based on trends.

Figure 1 shows the implementation and outcome in 150 NSTEMI/STEMI patients (77% males, 63 (45–85)) years. All eligible patients with moderate and good left ventricular function were stratified on day one at the CCU during the clinical rounds. A nurse initiates the novel ACS care plan, incorporating lab orders, intervention summaries, behavior goals, and medication.

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All consented patients had their app activated and were monitored for 365 days. The app tracks blood pressure, heart rate, weight, symptoms, and activity as reported by the patient. The app is connected to the electronic health record, and all measurements are presented in that environment. Patients provided their weight, blood pressure, and heart rate every 14 days, and their number of steps every month.

Educational videos and tips were delivered weekly via a newsfeed, matching the patients recovery phase and risk profile. All patients received a message on each working day during the first 2 months. Initially, the focus was on educational information, but in the subsequent months, the messages became more focused on lifestyle changes/adherence and contain motivational tools. Active smokers received every 28 days a quit smoking question/advice.

In all cases, nurses of the NWZ monitoring center were able to monitor patient dashboards, chat with patients, respond to questions, and push custom content or follow-up questionnaires. Only unexpected out-of-range laboratory values were forwarded through the monitoring center nurses to the attending nurse practitioner.

Audiovisual consults replaced physical visits when needed. Individual trends were used to plan follow-ups and inform medication changes or interventions. The attending cardiologist was available for symptom interpretation and clinical decision-making. Thus, the first outpatient visit within 30 days was replaced by this telemonitoring concept in all but 8 (5%) patients, and none of the patients presented to the emergency department.