Digital health program for coronary artery disease: engagement, retention and remote patient symptom assessment in a randomized controlled trial

Abstract Background Digital health programs have the potential to enhance secondary prevention strategies for coronary artery disease (CAD) by enabling remote patient monitoring (RPM) and improving long-term disease management. Patient engagement and retention within these programs play a crucial role in maximising their effectiveness. This randomized controlled trial (RCT) evaluated the effectiveness of a 6-month digital health program alongside standard care (SoC) for patients with CAD receiving care at a university hospital. Here we present key exploratory outcomes for the intervention group, specifically for digital engagement metrics. Purpose To assess digital engagement, program retention, satisfaction, and compliance with RPM surveys and changes in self-reported symptom severity in the intervention group. Methods A single-center, parallel-group RCT was conducted with 200 patients with CAD post-percutaneous coronary intervention (PCI), randomized to receive a digital health program + SoC (n=98) or SoC alone. The digital health program included remote patient monitoring, disease-specific education, motivational messages and content promoting healthier lifestyle. Symptom severity was assessed using the RPM questionnaire, which included core questions on breathlessness, chest pain, medication adherence, and side effects. Responses were categorized into high, medium, or low severity based on a predefined scoring system developed by experts to guide clinical follow-up. Results A total of 97 participants engaged with the digital health program after the first week, 79.6% males, average age 63.9 years. Over the 6-month intervention, 86% (83/97) completed the program, and 71% (69/97) remained active for the full duration. The median active days per week was 5.75 (IQR 3.67–6.92). After 24 weeks, 84% (81/97) of users were still retained. The weekly RPM completion rate was 94% during the intervention phase. In a complete case analysis (n=75) of the RPM questionnaire, the symptom severity improved over time, with the proportion of users reporting low-severity symptoms increasing from 57% in Week 1 to 83% in Week 24 (McNemar’s test: p 0.001). Users reported motivation and perceived benefits from the program. Overall, 68% of users felt the app motivated them to improve their lifestyle habits, and 76% found it helpful for understanding lifestyle improvements. Additionally, 83% of users indicated they were likely to recommend the app. Conclusion Users of the digital health program demonstrated high engagement, strong retention, and robust compliance with remote monitoring. The program was perceived as valuable, helping users better understand healthy habits, increasing motivation, and leading to a strong likelihood of recommendation. The high compliance with RPM surveys and reduction in symptom severity highlight the potential of digital interventions to enhance CAD management and secondary prevention.