Smartphone-based nursing intervention reduces pain after coronary artery bypass grafting

BACKGROUND: Patients after coronary artery bypass grafting often face suboptimal recovery, including pain, reduced quality of life, and haemodynamic instability, worsened by limited self-care knowledge and inadequate post-discharge support. Nurse-led smartphone-based interventions may offer a scalable solution for resource-limited settings. OBJECTIVE: To evaluate the effects of a nurse-led, smartphone-based educational and follow-up intervention on pain, quality of life, and haemodynamic stability in patients undergoing elective coronary artery bypass grafting. DESIGN: Single-blind, randomized controlled trial. SETTINGS: A tertiary cardiac surgery center in Shiraz, Iran, from July 2024 to April 2025. PARTICIPANTS: Eighty-four adults undergoing elective coronary artery bypass grafting, randomized (1:1) to intervention or control groups, with 80 completing the study (40 per group). METHODS: The intervention group received a three-phase programme: (1) pre-operative education via videos, messages, and a face-to-face session; (2) in-hospital education and daily symptom monitoring for pain and self-care; (3) 30-day post-discharge follow-up with weekly nurse-led calls and real-time messaging. Controls received standard care with one handout. Outcomes included pain (visual analog scale), quality of life (SF-36 Health Survey), and hemodynamic indices (blood pressure, heart rate). Pain and haemodynamic indices were assessed at baseline, three times daily for four days in the general ward following post-intensive care unit discharge (12 time points), and weekly post-discharge (days 7, 14, 21, 30; 4 time points), totaling 17 assessments. Quality of life was assessed at baseline and 30 days post-discharge. Data were analyzed using Mann-Whitney U tests, t-tests, and repeated-measures analysis of variance. RESULTS: The intervention group had lower pain scores (in-hospital: 3.96 ± 0.42 vs. 4.29 ± 0.35, p < 0.001, d = -0.85, 95% CI -0.50 to -0.16; post-discharge: 1.45 ± 0.38 vs. 2.01 ± 0.50, p < 0.001, d = -1.26, 95% CI -0.76 to -0.36) and reduced post-discharge blood pressure and heart rate. Total quality of life scores showed no significant between-group differences at 30 days (adjusted ANCOVA: adjusted mean difference = 0.15, 95% CI -1.27 to 1.57, p = 0.832), while the pain domain improved significantly in the intervention group (p = 0.002, r = -0.35). Group-by-time interactions were significant for pain and haemodynamic outcomes (p < 0.05). CONCLUSIONS: This nurse-led, smartphone-based intervention reduced pain, improved pain-related quality of life, and stabilized haemodynamic parameters post-coronary artery bypass grafting. Easily integrated into nursing practice, it supports recovery in resource-limited settings and merits further study. REGISTRATION: Registered at the Iranian Registry of Clinical Trials, IRCT20240426061574N1, registered June 05, 2024, https://irct.behdasht.gov.ir/search/result?query=IRCT20240426061574N1. SOCIAL MEDIA ABSTRACT: Nurse-led smartphone intervention reduces pain and stabilizes haemodynamics in post-coronary artery bypass grafting patients over 30 days.