Avatar-Based Serious Game for Cardiac Rehabilitation After Heart Attack

Effectiveness of an Avatar-Based Serious Game in Facilitating Transition to Cardiac Rehabilitation After Myocardial Infarction: A Randomized Controlled Trial

This study looks at whether a tablet-based education game helps people recover better after a heart attack. When people leave the hospital after a heart attack, they are usually given advice about their medicines, follow-up visits, cardiac rehabilitation, and warning signs to watch for. Many people find it hard to remember all of this information later at home.

In this study, adults who were treated in hospital for a heart attack were divided by chance into two groups. One group received the usual face-to-face education before going home. The other group used an interactive avatar-based education game on a tablet, in which a guide character walks the patient through the same topics. The game could also be used at home for one month after discharge.

The researchers measured how much patients knew about their heart disease, their quality of life, whether they attended cardiac rehabilitation, and whether they were readmitted to hospital. These were checked before discharge and again at 1, 3, and 6 months. The goal is to learn whether the avatar-based game helps patients understand and manage their condition better than usual education.

Study Overview

• Status: Completed
• Conditions: Cardiac Rehabilitation; Myocardial Infarction (MI)
• Intervention / Treatment: Behavioral: Standard discharge education; Behavioral: Avatar-based discharge education application

• Study Type: Interventional
• Enrollment (Actual): 75
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Isparta, Turkey (Türkiye)
    • Suleyman Demirel University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Confirmed ST-elevation or non-ST-elevation myocardial infarction during the current admission or within the preceding three months, including patients readmitted for revascularization (percutaneous coronary intervention or coronary artery bypass grafting)
• Planned discharge to home
• Able to operate a tablet computer or a smart phone
• Provided written informed consent

Exclusion Criteria:

• Insufficient Turkish-language proficiency to engage with the application or study procedures
• Severe comorbidity precluding engagement in lifestyle behaviour change or exercise
• Significant cognitive or visual impairment
• Concurrent enrolment in another interventional study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control group	Behavioral: Standard discharge education; Standard face-to-face discharge education delivered individually by the principal investigator before discharge, covering medication management, personal health record keeping, follow-up continuity and cardiac rehabilitation, and recognition of warning signs.
Experimental: Avatar-based education group	Behavioral: Avatar-based discharge education application; Tablet-based, avatar-guided discharge education application structured around Coleman's Care Transitions Intervention model (medication management, personal health record, follow-up continuity, and recognition of warning signs), delivered through interactive, persona-adapted, scenario-based gameplay before discharge and accessible for one month afterwards.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Coronary artery disease knowledge (CADE-Q II)	Disease-related knowledge measured with the Coronary Artery Disease Education Questionnaire II (CADE-Q II), a 31-item instrument scored 0-93, with higher scores indicating greater knowledge.	Post-intervention and at 1, 3, and 6 months after discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health-related quality of life (HeartQoL)	Disease-specific health-related quality of life measured with the HeartQoL questionnaire (14 items, total score 0-42), with higher scores indicating better quality of life.	Post-intervention and at 1, 3, and 6 months after discharge

Collaborators and Investigators

• Sponsor: Suleyman Demirel University

Publications and helpful links

General Publications

• doi.org/10.1093/ehjdh/ztaf036

Study record dates

Study Major Dates

• Study Start (Actual): September 22, 2025
• Primary Completion (Actual): January 6, 2026
• Study Completion (Actual): May 30, 2026

Study Registration Dates

• First Submitted: July 9, 2026
• First Submitted That Met QC Criteria: July 9, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 16, 2026
• Last Update Submitted That Met QC Criteria: July 15, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Heart Diseases; Infarction; Necrosis; Myocardial Ischemia; Ischemia; Pathological Conditions, Signs and Symptoms; Myocardial Infarction
• Other Study ID Numbers: E.1043124

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared publicly to protect participant privacy and in accordance with the approval conditions of the ethics committee and the informed consent obtained from participants. De-identified data may be made available from the corresponding author on reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No