Trends in digital healthcare adoption and its effectiveness for discharged patients with coronary artery disease across different phases of the COVID-19 pandemic in china

Background Recent studies have demonstrated that digital health management exerts a positive impact on chronic disease management and prognosis, yet more evidence is needed to substantiate its effectiveness in discharged patients with coronary heart disease (CAD), and more importantly, its efficacy during public health emergencies remains to be investigated. Methods Data for this study were derived from the HeartMed Digital Management System. Based on stringent inclusion and exclusion criteria, a total of 24,129 patients with CAD were enrolled, with an overall planned follow-up period of one year. Participants were categorized into three distinct eras—pre-COVID-19, COVID-19, and post-COVID-19—according to their enrollment dates. Within each era, participants were divided into the Digital Health Management (DM) group or the Conventional Management (CM) group based on participants' preferences and selection. The primary endpoint was all-cause mortality, while secondary endpoints included readmission, MACE and MACCE. Cox proportional hazards models were employed to assess the impact of digital health management on clinical outcomes across the different pandemic eras, with full adjustment for potential confounding factors. Additionally, interaction analyses between COVID-19 pandemic phases and digital healthcare were performed. Results During the pre-COVID era, 13,473 patients were enrolled, with 16.7% opting for DM. The COVID era comprised 5,173 patients, of which 80.3% choosing DM. in contrast, 5,483 patients included in the post-COVID era, 86.2% of whom selected DM. For the primary endpoint, digital healthcare significantly reduced risk across all three periods after full adjustment: pre-COVID era (hazard ratio [HR] 0.23 [95% CI 0.16–0.33], p < 0.001); COVID era (HR 0.52 [95% CI 0.31–0.86], p < 0.001); and post-COVID era (HR 0.58 [95% CI 0.36–0.94], p < 0.001). No significant differences were observed in the protective effect of DM on all-cause mortality among the three eras (all interaction p > 0.05). Similar trends were observed for the secondary endpoints. Conclusions With the evolving times and advancements in internet technology, coupled with having experienced the COVID-19 pandemic, there has been a growing preference for digital healthcare follow-up. Across all three pandemic phases, DM consistently demonstrated its effectiveness in reducing all-cause mortality, readmission rates, MACE, and MACCE events in CAD populations.Operating Diagram of HeartMed Digital Healthcare and adverse events