Randomized Trial of Remote Assessment of Patients After an Acute Coronary Syndrome

• Published in: Journal of the American College of Cardiology Vol. 83; no. 23; pp. 2250 - 2259
• Main Authors: Alshahrani, Nasser S., Hartley, Adam, Howard, James, Hajhosseiny, Reza, Khawaja, Saud, Seligman, Henry, Akbari, Tamim, Alharbi, Badr A., Bassett, Paul, Al-Lamee, Rasha, Francis, Darrel, Kaura, Amit, Kelshiker, Mihir A., Peters, Nicholas S., Khamis, Ramzi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 11.06.2024
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - therapy; Aged; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; myocardial infarction; Patient Readmission - statistics & numerical data; rehospitalization; remote monitoring; Telemedicine; telemedicine; ACS; acute coronary syndrome; myocardial infarction; rehospitalization; ECG; remote monitoring
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2024.03.398

Telemedicine programs can provide remote diagnostic information to aid clinical decisions that could optimize care and reduce unplanned readmissions post–acute coronary syndrome (ACS). TELE-ACS (Remote Acute Assessment of Patients With High Cardiovascular Risk Post-Acute Coronary Syndrome) is a randomized controlled trial that aims to compare a telemedicine-based approach vs standard care in patients following ACS. Patients were suitable for inclusion with at least 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. 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 (HR: 0.24; 95% 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. The TELE-ACS study has shown 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. (Telemedicine in High-Risk Cardiovascular Patients Post-ACS [TELE-ACS]; NCT05015634) [Display omitted]