Impact of COVID-19 on digital health literacy in acute coronary syndrome patients: a post-pandemic perspective in the greek population

The COVID-19 pandemic accelerated the adoption of digital health technologies, especially for patients with chronic diseases such as acute coronary syndrome (ACS). However, the impact of this rapid digital transformation on digital health literacy (DHL) among ACS patients in Greece remains unclear, particularly in the post-pandemic era. To evaluate changes in digital health literacy and the use of digital health services among ACS patients in Heraklion, Crete, Greece, across pre-pandemic, pandemic, and post-pandemic periods.

A retrospective cohort study was conducted involving adults (≥18 years) hospitalized for ACS in the two major hospitals of Heraklion, Crete, from January 2019 to June 2023. Patients were identified via electronic health records and contacted by telephone for additional information on digital health service use and DHL. DHL was assessed using an 8-item questionnaire, categorizing literacy as good, moderate, or poor. Data were analyzed by time period: pre-COVID-19 (2019), COVID-19 (2020–2022), and post-COVID-19 (2023). Statistical analyses included chi-square tests, ANOVA, and Bonferroni correction for multiple comparisons.

A total of 1,177 ACS patients were included (pre-COVID: 252; COVID: 702; post-COVID: 223). Digital health literacy levels varied significantly across periods. The proportion of patients with good DHL peaked during the COVID period (57.1%), compared to pre-COVID (42.9%) and declined to zero post-COVID. Moderate DHL increased during COVID (54.4%) and remained elevated post-COVID (28.2%) compared to pre-COVID (17.4%). The percentage of patients with poor DHL peaked during COVID (61.9%) and decreased substantially post-COVID (14.9%), lower than pre-COVID (23.1%) (p<0.001). Use of electronic prescription services increased markedly during COVID (60.7% vs. 16.2% pre-COVID), but declined post-COVID (23.2%). Remote appointment booking (online/phone) increased during the pandemic, with partial reversion to in-person bookings post-pandemic.

The COVID-19 pandemic significantly accelerated digital health literacy and digital service utilization among ACS patients in Greece. However, sustaining these advances post-pandemic remains a challenge, with a notable decline in good DHL and digital service use after the pandemic. Targeted interventions are needed to maintain and further improve digital health literacy and equitable access to digital health services in this vulnerable population.