Key result
Post-COVID era is linked to improved secondary prevention behaviors, with ~78% follow-up rates.
Why the study?
Evidence on digital health literacy evolution among acute coronary syndrome patients in Southern Europe during the COVID-19 pandemic was limited.
Observational (n=1,177)
Yes
Structured nurse-led follow-up may support improved secondary prevention behaviors and digital health literacy among ACS patients in the post-COVID era.
Answers are grounded in this paper and cite their sources.
May inform post-pandemic ACS follow-up strategies; hypothesis-generating for digital literacy gains and requires prospective confirmation.
Background The COVID-19 pandemic profoundly disrupted cardiovascular care pathways and accelerated the uptake of digital health solutions. Cardiovascular nurses play a central role in education, follow-up coordination, self-management support, and secondary prevention. Digital health literacy (DHL) has emerged as a key determinant of patients’ ability to access, understand, and use digital services, yet evidence on DHL evolution among acute coronary syndrome (ACS) patients in Southern Europe remains limited. Purpose To examine changes in clinical characteristics, follow-up behaviors, and digital health literacy among ACS patients across pre-COVID, COVID, and post-COVID periods, highlighting the contribution and feasibility of nurse-led follow-up in real-world secondary prevention. Methods A retrospective observational study was conducted including 1,177 ACS patients admitted to two tertiary hospitals. Three periods were analyzed: pre-COVID (2019), COVID (2020–2022), and post-COVID (2023). Demographics, clinical parameters, and prevention-related behaviors were extracted from hospital records and complemented through structured nurse-led follow-up contacts. A cardiovascular nurse conducted repeated patient communications to verify and complete missing information on risk factors, follow-up attendance, laboratory testing, medication adherence, and digital health literacy indicators (e.g., use of e-prescription services, online health information seeking, and digital communication with healthcare providers). Group comparisons were performed using chi-square tests and ANOVA with Bonferroni correction. Results ACS case distribution differed significantly across periods (p<0.001). During COVID, patients more frequently presented with diabetes, obesity, and smoking, indicating higher cardiovascular risk profiles. In the post-COVID period, STEMI presentations were more common. Significant differences were observed in key clinical parameters, including troponin levels, systolic blood pressure, and oxygen saturation (all p<0.05). Follow-up behavior's improved markedly post-COVID, with higher follow-up rates (78%, p<0.001), more frequent cardiovascular evaluations, increased laboratory testing, and improved medication adherence. DHL differed significantly across periods and was highest in the post-COVID era (p<0.001). Conclusion Post-COVID improvements in secondary prevention behaviors and DHL highlight the value of nurse-led follow-up in strengthening digital engagement and continuity of care. Integrating DHL assessment and targeted nursing support may may improve outcomes and strengthen healthcare resilience.
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Bouchalaki et al. (2026) conducted an observational in Acute coronary syndrome (ACS) (n=1,177). Post-COVID period vs. Pre-COVID (2019) and COVID (2020-2022) periods was evaluated on Follow-up behaviors and digital health literacy (DHL) (p=<0.001). The post-COVID period was associated with improved secondary prevention behaviors, including higher follow-up rates and increased digital health literacy.
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