Telemedicine reduces hospital readmissions after ACS
ACC.24 – Using a telemedicine-based approach for post-ACS patients in the UK reduced readmissions, emergency department visits, unplanned coronary revascularizations, and patient-reported symptoms compared with standard care.
This summary is based on the presentation of Nasser Alshahrani, MSc (London, UK and Abha, Saudi Arabia) at the ACC.24 Scientific Session - Remote Acute Assessment Of Patients With High Cardiovascular Risk Post-acute Coronary Syndrome (TELE-ACS).
Introduction and methods
Following ACS, ~7% of patients die within 1 month of hospital discharge and up to 25% need to be readmitted. Almost half of these readmissions have a noncardiac cause. A telemonitoring system could potentially provide effective assessment of symptomatic patients following ACS and thereby reduce hospital readmissions.
The TELE-ACS (Remote Acute Assessment of Patients with High Cardiovascular Risk Post-Acute Coronary Syndrome) trial was an RCT conducted at large tertiary center in London, UK in which 337 patients with ACS and ≥1 additional CVD risk factor who underwent PCI as an inpatient were included. Participants were randomized before discharge to a telemedicine-based approach (comprising at-home monitoring with a 12-lead ECG belt, automated blood pressure monitor, and pulse oximeter, coupled with remote clinical assessment performed by an on-call cardiologist) or standard care for 6 months. In the intervention arm, a novel (internally validated) clinical decision support algorithm was used to assist the cardiologist in their decision-making.
The primary endpoint was the time to first hospital readmission at 6 months. Key secondary endpoints included time to first hospital readmission at 9 months; total length of hospital stay at 3, 6, and 9 months; MACE (MI, stroke, and all-cause mortality); medical intervention; time to emergency department (ED) visits; and patient-reported quality of life outcome measures.
Main results
- The hospital readmission rate at 6 months was lower in patients randomized to the telemedicine-based approach (n=169) than those receiving standard care (n=168) (8% vs. 29%; HR: 0.24; 95%CI: 0.13–0.44; P<0.001).
- At 9 months (3 months after cessation of the intervention), the readmission rate was also lower in the telemedicine group (12% vs. 30%; HR: 0.35; 95%CI: 0.21–0.59; P<0.001).
- The total length of stay was shorter in the telemedicine group than in the standard-care group at 3 months (mean difference: –0.5 days; P<0.001), at 6 months (mean difference: –0.9 days; P<0.001), and at 9 months (mean difference: –0.6 days; P<0.001).
- The number of ED visits was lower in the telemedicine group at both 6 months (24% vs. 37%; HR: 0.59; 95%CI: 0.40–0.89; P=0.01) and 9 months (32% vs. 44%; HR: 0.66; 95%CI: 0.46–0.94; P=0.02).
- There was no significant difference in 6-month MACE rate between the two groups, although the number of patients with an MI was reduced in the telemedicine group compared with the standard-care group (7% vs. 22%; HR: 0.27; 95%CI: 0.14–0.53; P<0.001).
- In the telemedicine group, fewer unplanned coronary revascularizations occurred at 6 months (3% vs. 9%; difference: –7%; 95%CI: –12% to –2%; P=0.01) and 9 months (3% vs. 10%; difference: –6%; 95%CI: –11% to –1%; P=0.03).
- The frequency of patient-reported symptoms, such as shortness of breath (21% vs. 39%; P=0.001) and chest pain (9% vs. 24%; P=0.001), at 6 months was lower in the telemedicine group than in the standard-care group.
Conclusion
In the single-center TELE-ACS trial, the use of a telemedicine-based approach for the management of post-ACS patients was associated with reductions in hospital readmissions, ED visits, unplanned coronary revascularizations, and patient-reported symptoms compared with standard care.
Mr. Alshahrani pointed out that 86% of the study participants were male and may therefore not represent the global ACS population.
- Our reporting is based on the information provided at the ACC.24 Scientific Session -