## 1 Introduction  
There has been considerable interest from hospitals and clinicians to better understand and improve modifiable factors associated with 30-day hospital readmissions [1; 2; 3; 4; 5]. However, there are limited data available describing relatively contemporary trends in 30-day prehospitalization among patients who survive hospitalization after an acute coronary syndrome (ACS) event [1; 2; 3]. A recent study from the United States of America has shown, of all cardiac readmissions within 30 days of hospitalization, the majority occurred within 15 days (67.6%, acute myocardial infarction and 61.0% heart failure). Neither readmission diagnoses nor timing substantively varied by age, sex, or race [6]. Hospitalized patients commonly become deconditioned during hospitalisation and, as a result, often develop impaired stamina, coordination, and strength, which place them at greater risk for accidents and falls [3]. These limitations may also diminish their ability to adhere to post-discharge instructions such as the capacity to resume basic activities or attend follow-up appointments. Although, most of the identified risk factors for 30-day readmissions are not readily modifiable (i.e., socioeconomic and comorbidities) understanding the gaps that exist in current post-discharge education practices will improve outcomes [1; 2; 3; 4; 5]. Currently, there is limited evidence for the effectiveness of hospital discharge education in ACS or its cost effectiveness. Translation of innovative, patient-centred, intervention strategies will contribute to the reduction of 30-day re-hospitalisation rates of patients discharged from the hospital after an ACS event [6; 7; 8]. In 2018, we conducted a systematic review of published randomised controlled trials and found only three studies, with one hundred and seventy-five participants evaluating discharge education strategies for ACS [9]. In these three studies, the impact of inpatient educational interventions was assessed in relation to attendance of cardiac rehabilitation programs, exercise rates and medication adherence. The intervention groups had increased attendance to cardiac rehabilitation compared to the control groups (47.3% vs. 21.1%, respectively). The intervention groups also showed increased exercise rates from baseline to follow-up compared to the control group (\(p\) = 0.049). No difference was reported between the intervention and control for medication adherence (\(p\) = 0.881). None of the three studies reported on re-admission, mortality or cost-effectiveness. This limited evidence for practice highlights the need for rigorous evaluations of novel ACS discharge patient education interventions [9]. Acknowledging the limited evidence for discharge education, the National Heart Foundation of Australia provides general recovery advice via its website and printed resources [10; 11]. In this study we have used, as a conceptual framework, 'The 6 Steps to Recovery\" that the Heart Foundation advocate every nurse should discuss at the bedside before discharge [12]. The 6 Steps are: (1) Explain diagnosis and procedures; (2) Highlight risk factors relevant to the patient; (3) Emphasise the importance of cardiac rehabilitation; (4) Promote medication adherence; (5) Educate on the warning signs of heart attack and (6) Encourage follow-up with your doctor [12]. Other forms of post-discharge ACS education such as those presented at cardiac rehabilitation programs are often not accessed until several weeks after the event which may be past the point of buy-in for the patient. Additionally, the current uptake of cardiac rehabilitation (CR) and secondary prevention programs in Australia and around the world is between 20% and 46% [13]) so many ACS patients never receive this education. Previous research by our team has demonstrated a mismatch between access and attendance [14]. The majority of Australians have excellent geographic' access to cardiac rehabilitation (CR) and secondary prevention programs after discharge, but this has not translated to attendance [15].