Abstract P049: A Digital Therapeutic Intervention Is Feasible For Outpatient Care In Coronary Artery Disease
Authors: Arnar David O , Oddsson Saemundur , Gunnarsdottir Thrudur , Olafsdottir Inga V , Gudmundsdottir Maria V , Loftsson Kjartan H , Gudmundsson Elias F , Kaernested Bylgja , Amundadottir Maria L , Sigurdardottir Svala , Mogensen Brynjolfur , Libungan Berglind , Thorgeirsson Tryggvi 
Published: April 2022

Introduction:
Lifestyle and medication adherence are important factors in secondary coronary artery disease (CAD)-prevention. Furthermore, the mind-heart-body connection is gaining recognition in cardiovascular health management.

Hypothesis:
We assessed the hypothesis that a CAD-specific digital intervention is feasible for outpatient care in terms of program retention, satisfaction, quality of life, symptom frequency and medication adherence.

Methods:
A four-week CAD-program (SK-121) delivered via a smart phone was designed in collaboration between the National University Hospital of Iceland (NUHI) and Sidekick Health. Patient recruitment took place at NUHI, and program participation consisted of daily health promoting missions assigned within the digital intervention such as watching educational videos, mindfulness exercises, medication reminders and logging quality of life scores. Pre- and post-intervention questionnaires were administered for the Hospital anxiety and depression scale (HADS), Seattle Angina Questionnaire-7 (SAQ-7) and the Morisky medication adherence scale (MMAS-8). Stress-, energy-levels and quality of sleep were logged on a ten-point scale. Participants were interviewed about their program experience.

Results:
A total of 33 individuals signed informed consent and completed the baseline survey, of which 25 individuals registered in the app (76% males, mean age 60 years [SD=10]). A total of 23 participants logged a mission during the 4-week intervention, five of those were active a single day. A total of 16 (70%) participants completed the program and both pre- and post-surveys (mean age 60 years [SD=10], range 44-80 years). On average participants logged 7.5 missions/day (10.2 for women and 6.6 for men), completing half of daily missions (women 71%, men 47%). Results for average quality of life scores from week one to four were: for energy 5.5[SD=1.8] to 5.8[SD=1.9],
p
=0.22, for quality of sleep 6.2[SD=2.5] to 5.9[SD=2.4]
p
=0.20 and for stress 3.3[SD=2.6] to 3.3[SD=2.4]
p
=0.71.The proportion of the 16 patients who experienced CAD-symptoms in the last four weeks decreased from 56% at baseline to 38% at program completion,
p
<0.01.Medication adherence at baseline was 50% (8/16, MMAS-8=8) and increased as five of the eight (63%) non-adherent individuals became adherent,
p
=0.03.There were slight non-significant decreases in anxiety scores from 4.3 [SD=3.4] to 4.13[SD=2.9]
p
=0.88 and depression scores from 3.1 [SD=3.3] to 2.8[SD=3.6]
p
=0.33.User satisfaction was good as 75% of the 16 participants said it was likely that they would recommend the program, that it had a positive effect on their life, well-being and ability to deal with their disease.

Conclusions:
In conclusion, a CAD-specific digital intervention is feasible in terms of engagement, user satisfaction and improved treatment adherence. An RCT study is being planned to further test the program.