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Remote Assessment of Cardiac Patients Post-ACS
Quick Takes
- A post-discharge remote patient monitoring service for 6 months was associated with a reduced hazard of unplanned hospitalization compared with standard care among patients treated for ACS.
- Furthermore, the effect size of the remote monitoring protocol was large, with an HR of 0.24 in event-free survival in the active arm versus the standard of care over 6 months.
- Even after the intervention was withdrawn at 6 months, there was a sustained benefit of the intervention on unplanned hospitalizations, with an HR of 0.35 at 9 months.
Study Questions:
What is the impact of a patient-initiated remote monitoring service including 12-lead electrocardiogram (ECG), vital sign data, and algorithmically supported clinical review on the risk of readmission following acute coronary syndrome (ACS)?
Methods:
The investigators included patients with ≥1 cardiovascular risk factor and presenting with ACS and were randomized (1:1) before discharge. The primary outcome was time to first readmission at 6 months. Secondary outcomes included emergency department (ED) visits, major adverse cardiovascular events, and patient-reported symptoms. The primary analysis was performed according to intention to treat. Survival analysis using a Cox proportional hazard model and Kaplan-Meier estimator was used for the primary endpoint of time to readmission within 6 months of randomization, and the secondary endpoint of time to ED attendance.
Results:
A total of 337 patients were randomized from January 2022 to April 2023, with a 3.6% drop-out rate. The mean age was 58.1 years. There was a reduced rate of readmission over 6 months (hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.13-0.44; p < 0.001) and ED attendance (HR, 0.59; 95% CI, 0.40-0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm vs. 9% in standard therapy arm). The occurrence of chest pain (9% vs. 24%), breathlessness (21% vs. 39%), and dizziness (6% vs. 18%) at 6 months was lower in the telemedicine group.
Conclusions:
The authors report that a telemedicine-based approach for the management of patients following ACS was associated with a reduction in hospital readmission, ED visits, unplanned coronary revascularization, and patient-reported symptoms.
Perspective:
This randomized controlled trial involving patients treated for ACS reports that a post-discharge remote patient monitoring service for 6 months was associated with a reduced hazard of unplanned hospitalization compared with standard care. Furthermore, the effect size of the remote monitoring protocol was large, with an HR of 0.24 in event-free survival in the active arm versus the standard of care over 6 months. Of note, even after the intervention was withdrawn at 6 months, there was a sustained benefit of the intervention on unplanned hospitalizations, with an HR of 0.35 at 9 months. Additional studies are indicated to validate these findings and explore the feasibility and economic impact of this strategy in various health care systems.
Clinical Topics: Acute Coronary Syndromes, Prevention
Keywords: Acute Coronary Syndrome, Telemedicine
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