Triggered Acute Risk Prevention (TARP): Effect of a Novel Model of Care on Cardiovascular and Mental Health Outcomes.

An in-person appointment will be scheduled with site research nurse and potential participant, at which eligibility criteria will be confirmed, informed consent obtained and baseline characteristics and assessment performed. A one-month run-in phase shall commence following this appointment, with simulated medication administration and trigger entry in study app. Participant contacted weekly during this period, and data reviewed at three weeks (max four) for adherence. Suitable participants able to continue to randomised study phase. Suitable participants will be randomly allocated to TARP active or placebo intervention. TARP Active At the time, or after a participant experiences a trigger event, they will enter the following details into the study App, and be directed to respond according to the trigger severity level entered: 1. Trigger type (acute anger, emotional stress, heavy exertion, heavy meals, respiratory infection, or pollution) and severity 2. Cause of trigger 3. Date and Time of triggering event 4. Current heart rate at time of entering trigger 5. Medication taken, date and time taken (if medication required according to severity entered) If level of risk is above a pre-set threshold, the App will direct the participant to take the study medicines: • Blue packet containing propranolol and aspirin for acute anger, emotional stress and heavy exertion, • Yellow packet containing aspirin for heavy meals, respiratory infection and pollution. Medication Dosage and Route of Administration TARP active dosage is: Propranolol 10mg orally and Aspirin 100mg orally as required, with one repeat dosage allowed 4 hours or more after first dose, to a maximum of 2 doses per day, OR Aspirin 100mg orally as required, once per day. Participants will receive a follow-up reminder at 2 hours post medication administration (according to the time taken entered at step 5 above). They will be asked to enter their current heart rate and current rating of trigger severity at time of entering follow-up. The approximate duration of time taken to engage with the study app on each occasion should be 5 minutes or less. If level of risk is below a pre-set threshold, the App will direct the participant that: "This level of (trigger name) does not require study medication or need to be entered into the App. If your level of (trigger name) increases please re-assess the trigger using the App as your medication requirement may change. We recommend you visit the Education Portal for useful information on managing anger and wellbeing." Adherence will be monitored by the Investigators through the App Management console, with app analytics evaluated for all data captured during participant trigger entry (steps 1-5). In addition, monthly phone interviews will be conducted by Research Nurse with study participants to collect information on participant experiences. The study consists of a one-month run-in phase, and a 6-month active randomised (medication or placebo) study period.