INTERCEPT: a feasibility study of a digital intervention by nurse prescribers for secondary prevention of cardiovascular disease

Abstract Background Patients with coronary disease are commonly diagnosed, revascularised and discharged from hospital within 24-72 hours and only about one third access cardiac rehabilitation often with delays of weeks before joining such programmes. Purpose To bridge this care gap we developed the INTERCEPT digital model for secondary prevention. It comprises an I-App on a smart device, linked to wearables, and a Health Professional Portal overseen by a nurse prescriber in hospital to monitor and manage patients virtually. It was developed by co-design with patients, health professionals and a software company. The I-App encompasses lifestyle, risk factor control to targets and cardioprotective medications. Methods We conducted a feasibility study in the CCU/CTU at a University Hospital in patients with an acute coronary syndrome or elective revascularisation. The primary objective was to examine the feasibility of patient recruitment, engagement and usage from the I-App analytical data and acceptability of this form of preventive care among patients through qualitative interviews. Results 40 patients were recruited: mean age of 61.9 years (13% female); 56% STEMI/NSTEMI, 18% unstable angina, 26% elective PTCA/CABG. 25% were smoking, Mediterranean diet score 6.5 (SD 1.8), 87% BMI > 25 Kg/m2 and 68% low or moderate (IPAQ) physical activity. HADS: 27% anxiety >8 and 14% depression score >8. 58% had a BP <130/80 mmHg, 21% had a LDL-C <1.4 mmol/l and 29% of those with diabetes had a HbA1c <53. The commonest reason for non-enrolment was not owning a smart phone followed by early transfer back to the referring hospital and no interest in technology or research. For the patients recruited retention of I-App usage was 100%. Total number of I-App views was 25,965 (average 7.2 times per user per day) over 3 months. The most frequently viewed pages were: ‘My numbers’ (weight, waist, cholesterol, blood glucose, HbA1c); ‘My devices’ (heart rate, blood pressure, steps, active minutes); ‘My health tracker’ (healthy eating, physical activity, mood); ‘Medications’(reminders); and ‘Goals’. Qualitative interviews with 11 patients revealed the I-App as a trusted source of information, education and inspiration providing: (i) information in their hands and recording daily activities and medications; (ii) remote monitoring by the nurse providing reassurance, confidence and actions; (iii) self-management through prompts motivating goal setting and tracking progress. Conclusion The INTERCEPT programme bridged the gap in preventive care but not having a smart phone and rapid discharge limited recruitment. Patients require immediate support following discharge to address lifestyle, risk factors and medication adherence all provided by the INTERCEPT digital intervention. The I-App information was trusted, provided reassurance and encouraged self-management. We now plan to test INTERCEPT in a cluster randomised controlled trial to evaluate clinical and cost effectiveness.INTERCEPT App and Portal