Digital peer support enters the recovery gap after heart disease
Cardiac rehabilitation lowers morbidity and improves quality of life, yet many people never complete it, cannot access it, or disengage before the program can do its job. Heart2Heart is designed around that failure point. The community-based trial will test whether a digital peer support program can strengthen social connectedness in adults living with heart disease and, in turn, improve recovery-related outcomes that matter well beyond the clinic visit.
The study is being conducted in Australia as an investigator-blinded randomised controlled trial with six months of follow-up for the primary endpoint and additional assessments at 6 and 12 months for secondary outcomes. About 752 adults with a diagnosis of heart disease in the previous 12 months will be recruited from the general community and from Australian cardiac rehabilitation programs. Participants will receive either usual care alone or usual care plus a six-month peer support intervention delivered through an interactive mobile application.
The clinical logic is straightforward. Heart disease often forces people into a long stretch of uncertainty after the acute event has passed but before confidence in daily life returns. Social isolation can amplify that period, reducing motivation to exercise, adhere to medication, and re-engage with ordinary routines. A structured digital environment with discussion groups, educational resources, and facilitated conversations with health professionals could reduce that isolation while making recovery feel more navigable.
A mobile platform built to extend cardiac rehabilitation beyond the gym
The intervention combines online discussion groups, access to resources, and guided conversations with health professionals inside a mobile application. In practical terms, it is meant to supplement, not replace, standard care. The control group will continue with usual care, allowing the trial to isolate whether the digital peer model adds measurable value over what patients already receive.
One short sentence captures the central hypothesis: peer connection may improve recovery because heart disease is not only a cardiovascular disorder, but also a social and behavioral one.
The primary outcome is social connectedness at 6 months. That choice signals an important shift in how recovery is being conceptualized. Traditional cardiac trials often focus on events, biomarkers, or exercise capacity alone. Here, the study places connectedness at the center, recognizing that feeling linked to others may shape whether a person keeps taking prescribed medications, returns to activity, and engages with rehabilitation in the first place.
Secondary outcomes are broad and clinically relevant. At 6 and 12 months, the trial will assess all-cause and cardiovascular disease hospital admissions, all-cause mortality, lifestyle behaviors such as physical activity, smoking, and fruit and vegetable intake, as well as the proportion taking prescribed medications. Health service use will also be tracked, including medical appointments, cardiac rehabilitation attendance, and participation in any other in-person peer support activities.
What the investigators will measure beyond hospital readmissions
The protocol extends beyond hard clinical events and captures the patient experience directly. Self-efficacy, quality of life, satisfaction, and program engagement will be analyzed at 6 months. Those measures matter because digital health programs can fail in subtle ways long before any mortality or hospitalization signal appears. If participants open the app but do not participate, or if the material is useful but too passive to sustain engagement, the intervention will lose the mechanism it needs to influence behavior.
Process evaluation is a core feature of the trial. Application analytics will show how people actually use the platform, while participant feedback will identify barriers and facilitators to engagement. That design is clinically useful because digital support programs often live or die by adherence, not by theoretical appeal. A program may be elegant on paper and still fail if users find it burdensome, impersonal, or disconnected from their day-to-day recovery challenges.
The trial uses an intention-to-treat analysis, preserving the original randomization structure even if participants do not use the app as intended. That approach is especially important in digital behavior-change studies, where drop-off and incomplete use are part of the real-world problem. It keeps the results anchored to the practical question clinicians actually face: what happens when this program is offered to a broad population of people recovering from heart disease?
Why connectedness may influence cardiovascular recovery
Peer support may matter because it addresses several drivers of post-event risk at once. People recovering from heart disease frequently need help maintaining medication routines, resuming physical activity, and rebuilding confidence after hospitalization or a cardiac rehabilitation referral. Social connection can reinforce each of those behaviors. It may also reduce the sense of being alone with a diagnosis that often changes sleep, mood, work, and family roles in the same month.
A digital format carries its own advantages. It can reach people who live far from rehabilitation centers, struggle with transport, or cannot attend in-person sessions consistently. It may also lower the threshold for participation by allowing interaction from home during the period when confidence and energy are still uneven. In that sense, Heart2Heart is testing not just a platform, but a delivery model for chronic cardiovascular recovery.
Ethical clearance was obtained from the Western Sydney Local Health District Ethics Committee, and the trial is registered under ACTRN12624000386538. The protocol is now positioned to answer whether digitally delivered peer support can fill one of cardiac rehabilitation’s persistent gaps: sustained human contact after discharge, when motivation often weakens and the risk of falling out of care rises.
If the intervention changes connectedness without shifting admissions, mortality, or health behaviors, it would still offer a precise lesson about what digital peer support can and cannot do. If the broader outcomes improve as well, the study could provide a realistic model for extending rehabilitation support into the home, where most recovery actually happens.