Digital Health Interventions for Cardiovascular Disease Prevention Within a Rapid Access Cardiology Model of Care

Background Cardiovascular disease (CVD) risk assessment can improve outcomes, but novel methods to identify high-risk patients and deliver prevention programs are needed. Rapid Access Cardiology (RAC) services can provide rapid risk assessment but have not been evaluated in Australia. Within RAC there is the potential to also implement systems that identify high-risk patients and manage risk using novel strategies. Mobile health (mHealth) provides a unique opportunity to deliver prevention programs and may influence behaviours. There is, however, limited evidence for mHealth efficacy in primary prevention. Aims To assess the utility of RAC to identify and manage patients at high-risk of CVD, and to leverage this opportunity to provide preventative care using mHealth. Methods and results Methods used include cohort studies, data audits, secondary analyses, and a randomised controlled trial (RCT). Part 1 evaluates the role of RAC for the assessment of suspected CVD and identifies gaps in risk factor assessment. RAC for chest pain and arrhythmia safely reduced unplanned hospitalisation. Many patients had multiple uncontrolled risk factors, but gaps exist in electronic data required to quantify risk. Part 2 examines the role of mHealth to improve CVD prevention, and identifies factors associated with effective text message-based programs. Message intent significantly influenced engagement. Patients with higher baseline risk were more likely to change behaviour. Part 3 evaluates text messages for CVD primary prevention via a RCT in higher risk patients from RAC. The primary outcome (difference in the proportion with 3 uncontrolled risk factors) was not significant at 6 months. However, the intervention improved risk factor control from baseline. Conclusion The results support a novel healthcare model which utilises digital health to optimise CV risk assessment and provide continued support to patients at elevated risk extending beyond the traditional clinical interface