Wide variability in studies reporting on digital education interventions for patients undergoing cardiac procedures: A patient-commissioned mixed methods systematic review

BACKGROUND: Although cardiac rehabilitation is widely acknowledged as the gold standard for improved outcomes in cardiac procedures, it remains underutilized. Digital education tools have the potential to improve access and adherence to cardiac rehabilitation. OBJECTIVES: The primary objective of this review is to determine the impact of digital education interventions for patients undergoing cardiac procedures on patient-level and health system-level outcomes. METHODS: Conceptualized by a patient partner, a mixed methods systematic review was conducted using JBI methodology. MEDLINE, Embase, CINAHL, and Scopus were searched. Studies were included if they reported on a digital education intervention for adult patients preparing for or recovering from cardiac procedures, and if they reported primary outcomes related to healthcare utilization, learning/knowledge, and/or patient-level health. Interventions were mapped onto the WHO taxonomy of Digital Health Interventions for Persons. RESULTS: 41 studies were included, and most reported a positive effect across several outcome categories: knowledge; behavior, attitude, and self-efficacy; physiological; healthcare utilization; mental health; quality of life; physical function and activity; and other. Considerable variation in outcomes, measurement instruments, and intervention characteristics hindered meta-analysis and made it challenging to draw broad conclusions. CONCLUSION: Overall, interventions included in this review resulted in a positive effect on a wide range of outcomes. However, most studies did not report the use of an educational theory or underlying framework, leading to wide variability in intervention design and implementation. Future developers should consider using an educational framework to design and evaluate digital interventions. Additionally, engaging patients and knowledge users as co-designers could increase relevance, acceptability, and uptake.