VIRTUES-CC

This study is being done to get feedback from cardiac patients on their experience using the VIRTUES application.

To get a general sense of your baseline characteristics, the study team will give you a survey to complete with sections on your demographics (i.e., gender, ethnic background, etc.), your medical history, and your intake of medications and/or substances.

The study team will give you clear instructions on how to download the VIRTUES application. Each of the 11 modules within VIRTUES will be tested in a given month. For example, we may begin in January with the module on blood thinning and in February, the module on managing blood pressure will take place. You will only participate in modules that are relevant to you. To continue with our example, if you have hypertension (high blood pressure), then you will participate in VIRTUES during the month of February when that module is being tested.

Halfway into the one-month VIRTUES module, at the 2-week timepoint, you will be given a link to a survey to complete. This survey allows you to provide feedback on your experience with the VIRTUES application thus far.

After completing the one-month VIRTUES module, you will be given the survey again to provide your feedback on using VIRTUES for the entire one-month duration. You will also be asked if you would like to be contacted to participate in a small focus group via video-conferencing (i.e., Zoom^Ó) with other participants. Participation in the focus group will give participants the opportunity to discuss openly their experience using VIRTUES and is optional.

Combined, the study procedures including obtaining informed consent and completing surveys will take approximately 4 hours over the course of one month. However, the VIRTUES application itself will also present you with educational material and recommendations to review which can add an approximate 2 hours per week to complete. Thus in total, the study will require approximately 11 hours over a month, but it may take more or less time depending on your specific needs.

As new modules are developed, you will be invited to participate in those for which you are eligible. For example, if you indicated in the baseline survey that you have been diagnosed with diabetes, then the module on managing your blood sugar is relevant to you. Once that module is developed, we will contact you via email to the email address that you provided indicating that you are eligible for the next module.

There are no known risks associated with participating in this study. However, the use of a mobile technology application that contains components of a your medical history and demographic information introduces the possibility of this information being obtained by people outside the circle of medical care. The VIRTUES platform has been designed by web-developers through CANet who have ensured its compliance with all applicable provincial and federal privacy laws and regulations to prevent this risk.

In addition, various precautions are in place to ensure that the recommendations are clear, evidence-based, and prioritize your safety above all else. To this end, the following actions are taken in developing the recommendations within the VIRTUES application:

• All recommendations will be reviewed by a physician prior to implementation to mitigate any
• Initial testing is all done ahead of time, such that no “nonsensical” recommendations will be suggested, which will reduce the possibility of confusion on any given recommendation.
• Recommendations are all in accordance with current Clinical Practice Guidelines from the Canadian Cardiovascular Society. Each recommendation will have levels of strength associated with the language (i.e., the term "recommend" is used with higher strength than the term "suggest" etc.).

It is also possible that recommendations from guidelines may not be up to date and accurate. To mitigate this risk, there will be a bimonthly review by the expert(s) in the field who helped develop the algorithm to ensure that the recommendations are up to date.

To account for drug contra-indications and interactions among medications, each recommendation to take a certain medication has an embedded code with existing drugs that may interact with it. This code ensures that participants are not recommended to take medications that may interact with one or more of their existing medications

And finally, to mitigate any potential risks of making recommendations based on inaccurate or incomplete data entered (i.e., blood pressure entry), it is noteworthy that recommendations are only enabled after a research team member reviews and approves the data that you have entered for accuracy and completeness.

The benefits of participation in this study may include a reduction in risk-factors that you may have, which in turn, may reduce your chances of future cardiac complications. For example, a patient with hypertension may benefit from increased information on blood pressure management and thus, subsequently reduce their elevated blood pressure.