A program that delivered in-home visits from a trained paramedic team to people with heart failure (HF) did not significantly reduce 30-day hospital readmissions or improve health status compared with standard follow-up phone calls, according to results from the MIGHTy-Heart study, presented in ACC.25 in Chicago. In contrast, a secondary prevention program that provided counseling on heart medications and lifestyle modifications by specially trained nurses to patients with an acute coronary syndrome (ACS) found a reduction in the primary composite outcome at five years, according to results from the ALLEPRE study. Both were presented in Late-Breaking Clinical Trial sessions.

MIGHTy-Heart enrolled 2,003 patients (median age 67 years, 52% women, 47% were Black, 27% Hispanic) who had been hospitalized for HF at one of 11 hospitals in New York City to either a mobile integrated health program or a phone call with a transition of care coordinator 48-72 hours after discharge.

In the mobile integrated health program, patients could request in-home visits from paramedics who assessed their symptoms and home environment in addition to setting up a laptop and internet connection for a live telehealth visit with a physician.

All participants were enrolled in Medicaid or Medicare. About 30%-40% also had ischemic cardiomyopathy, atrial fibrillation, diabetes or chronic kidney disease.

Results showed no significant difference between the two arms in hospital readmissions at 30 days. However, the results revealed differences by sex. Women were 30% less likely to be readmitted for an all-cause hospitalization and 36% less likely to have a HF-related readmission compared to men in the mobile integrated health arm.

The results also suggested that patients younger than 70 years old may be most likely to benefit from mobile integrated health. KCCQ scores improved in both study groups overall, but when patients older and younger than 70 years of age were analyzed separately, the improvement with mobile integrated health remained the same in both groups while younger patients saw less of an improvement with a transition of care coordinator.

"Our observational data suggests that the patients who are sicker and those who are more affected by social determinants of health (financial stressors, lack of caregiving support) likely benefit more from this intervention," said Ruth Masterson Creber, PhD, RN, the study's co-first author.

Although the study did not meet its co-primary endpoint for preventing readmissions overall or improving health status, researchers said the study provides evidence that the mobile integrated health program works well in a highly diverse population with a high burden of disease. The findings suggest the in-home program may be particularly beneficial for women with heart failure, as well as younger patients who did not respond as well to standard follow-up calls.

In the ALLEPRE study, the first and largest to assess a nurse-led cardiology intervention for an extended follow-up period, enrolled 2,057 patients treated for ACS at seven hospitals in Italy. Half of the patients received nurse-led follow-up and half received standard care. For the nurse-led group, patients had at least nine one-on-one sessions with a nurse coordinator starting when they were hospitalized for ACS and at one, three, six, 12, 18, 24, 36 and 48 months after discharge. Patients assigned to standard care followed the usual protocol for their treating hospital, which included at least three follow-up visits with their cardiologist over five years following their ACS hospitalization.

The nurses involved in the program received three days of specialized in-person training. During each visit, nurses met with patients and their caregivers to assess cardiovascular risk factors, check medication adherence and encourage lifestyle modifications. When needed, the nurses also referred patients to a multidisciplinary care team for additional cardiovascular and psychological support.

Results showed that, at five years, the rate of cardiovascular death, nonfatal myocardial infarction (MI) or nonfatal stroke – the study's primary composite endpoint – was 30% lower among patients receiving nurse-led follow-up care. This was primarily driven by a significant reduction in nonfatal MI. Rates of cardiovascular death or stroke were numerically lower among patients receiving nurse-led care, but the difference between groups was not statistically significant for these endpoints.

Patients receiving nurse-led follow-up showed significant improvements in physical activity and medication adherence, as well as a reduction in BMI compared with those who received standard care. There was no difference between groups in terms of smoking cessation or LDL-C.

"Nurses are very important, because they are often the first point of contact for patients and their caregivers. Patients often feel more comfortable talking with a nurse about lifestyle modification. As cardiologists, we do very well with treating the disease with drugs, but we are not as good with changing behaviors, which is the hardest part," said Giulia Magnani, MD, the study's first author. "Shifting cardiovascular risk assessment from physicians to other health care professionals may be a sustainable [way to enhance] the effectiveness and accessibility of care for secondary cardiovascular prevention."

Clinical Topics: Acute Coronary Syndromes

Keywords: ACC Annual Scientific Session, ACC25, Comparative Effectiveness, Telehealth, Team-Based Patient Care, Acute Coronary Syndrome