Digital health literacy for cardiovascular prevention: lessons from the COVID-19 pandemic among ACS patients in a southern european region

Background The COVID-19 pandemic disrupted cardiovascular care and highlighted the growing importance of digital health literacy (DHL)for maintaining preventive services. Evidence on how DHL evolved among acute coronary syndrome (ACS) patients inSouthern Europe remains limited. Purpose To evaluate changes in epidemiological patterns, clinical characteristics, follow-up behaviours, and digital health literacy among ACS patients across the pre-COVID, COVID and post-COVID periods. Methods A retrospective study of 1177 ACS patients admitted to two tertiary hospitals.Examining periods were defined as pre-COVID (2019), COVID (2020–2022) and post-COVID (2023). Demographic, clinical, admission, follow-up and digital literacy variables were compared using χ² tests and ANOVA with Bonferroni correction. Results Case distribution differed significantly (p<0.001): 21,4% pre-COVID, 19,8% COVID, 18.9% post-COVID. During the COVID period, patients more frequently had higher rates of diabetes, obesity, and smoking (all p<0.05). STEMI was most common post-COVID. Troponin levels was lowest pre-COVID, systolic blood pressure lowest during COVID, and oxygen saturation highest post-COVID (all p<0.05). Follow-up rates was significantly higher post-COVID (78%, p<0.001). Patients during this period also reported better overall health, more physician-specific follow-up, more recent cardiac evaluation, more frequent blood testing and higher medication adherence (all p<0.001). Digital health literacy differed across periods and was significantly highest post-COVID (p<0.001). Appointment-schedulling ways differed, although post-hoc comparisons were non-significant. Conclusion The COVID-19 period was associated with higher-risk ACS profiles, whereas the post-COVID period showed enhanced secondary prevention behaviors and substantially improved digital health literacy. Strengthening DHL should be a strategic priority to support cardiovascular prevention and system resilience during future disruptions.