TELEMEDICINE IN HIGH RISK CARDIOVASCULAR PATIENTS POST-ACS (TELE-ACS)
Research type
Research Study
Full title
Remote Acute Assessment of Patients with High Cardiovascular Risk Post-Acute Coronary Syndrome.
IRAS ID
291565
Contact name
Ramzi Khamis
Contact email
Sponsor organisation
Imperial College London
Clinicaltrials.gov Identifier
Duration of Study in the UK
4 years, 0 months, 1 days
Research summary
Research Summary
Myocardial infarction continues to be one of the leading causes of mortality in the UK, despite cutting edge medical and interventional therapy. As the length of stay in hospital for myocardial infarction decreases in line with global trends, UK unplanned readmission rates remain high at about 10% at 30-days. This is representative of global data, with a recent meta-analysis reporting 30-day readmission rates of between 11-14%, and are even higher in the USA. Several studies have previously analysed the readmissions rates for patients with Acute Coronary Syndrome (ACS) within 30-day, 3-month and 1-year. A study conducted in the USA reported women of all ages have a higher risk of readmission compared with men at 1-year after AMI and the readmission rate was 24.5%. These readmissions are for both cardiovascular causes (such as further myocardial infarction, anginal chest pain or heart failure) as well as non-cardiovascular causes, most prominently non-cardiac chest pain, in up to 50%. Regardless, the mortality in patients 30-days post-discharge for acute myocardial infarction is 7.3% with little change over time. Indeed the most current UK data of 30-day mortality in those undergoing coronary intervention for acute coronary syndromes varies between 1.6-43.1%, depending on the presence of ST-segment elevation and shock at presentation.
Against this background, this project aims to propose providing remote facilities for those most at risk, because utilisation of telemedicine devices has the potential of providing remote, clinically-driven, diagnostic information without the need for hospital attendance.
Our hypothesis is that the telemonitoring system would reduce hospital readmission for patients with high cardiovascular risk post-acute coronary syndrome by using well-validated technologies coupled with an urgent remote consultation with a cardiologist.
Summary of Results
In this study, people who had a recent heart attack or another acute heart problem were offered a telemedicine service to help them manage symptoms at home using a simple kit and rapid phone support from a cardiologist, compared with usual care after leaving hospital. The telemedicine kit included an easy-to-wear 12‑lead heart tracing belt, a blood pressure monitor, and a pulse oximeter, and patients were taught to use them before discharge and contacted quickly by the study team if they reported symptoms that might be heart-related.
The study included 337 adults with at least one risk factor for heart disease, and compared the two approaches for six months after hospital discharge, with additional follow-up to nine months to see if any benefits lasted after the telemedicine period ended. The main question was whether telemedicine could reduce the time to the first unplanned hospital readmission, and the study also looked at emergency department visits, need for further heart procedures, and common symptoms such as chest pain and breathlessness.
Telemedicine significantly reduced unplanned hospital readmissions over six months, meaning patients supported by the remote service were much less likely to be admitted back to hospital compared with those receiving usual care; this was measured using a standard statistic showing a strong reduction in risk. People in the telemedicine group also had fewer emergency department visits and fewer unplanned procedures to open blocked heart arteries during the study period.
Patients using telemedicine reported fewer symptoms at six months, including less chest pain, breathlessness, and dizziness, suggesting they felt better supported and more confident recognizing and managing symptoms at home with quick access to clinical advice when needed. These findings align with external summaries and news coverage highlighting that a structured telemedicine strategy after a heart attack can reduce readmissions and emergency visits while improving patient-reported symptoms.
Overall, the TELE-ACS study shows that providing patients with simple home monitoring tools plus rapid clinical review by a cardiologist can safely reduce hospital use and improve symptom control after a heart attack, which may help health services deliver timely care and keep patients well at home. Further information about the scientific publication and public summaries is available in the journal article and independent explainers that discuss how telemonitoring supports recovery after acute coronary syndrome.
Available at: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fpubmed.ncbi.nlm.nih.gov%252F38588928%252F%2FNBTI%2FoELAAQ%2FAQ%2F512fd64c-5c66-4a1a-8184-7a7e1e03c2e1%2F3%2Fi82tz6rIig&data=05%7C02%7Cfulham.rec%40hra.nhs.uk%7C206819068e4a42c2758a08ddfba2b96a%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638943398499626315%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=jGFLMk%2FRv%2FiPg1egJdTdAP9an1WWILCsMwdct6FTkyI%3D&reserved=0
REC name
London - Fulham Research Ethics Committee
REC reference
21/LO/0651
Date of REC Opinion
27 Oct 2021
REC opinion
Further Information Favourable Opinion