A robust telemedicine intervention across six months following an acute coronary syndrome (ACS) was associated with a reduction in hospital readmission, emergency department (ED) visits, unplanned coronary revascularization and patient-reported symptoms, according to a randomized study presented during a Featured Clinical Research session during ACC.24 and simultaneously published in JACC.

The investigator-initiated TELE-ACS study, conducted from January 2022 to April 2023 at a large tertiary center in London, UK, randomized 337 participants (mean age 58.1 years, 86.1% men, 46% White, 36% Asian, 11% Black) presenting with an ACS and at least one cardiovascular risk factor before discharge to either standard care or standard care plus telemedicine. Patients in the telemedicine arm were given a user-applied 12-lead electrocardiogram (EKG) belt that linked to their smart device and automatically transferred a copy of their EKG to the research team, as well as an automated blood pressure monitor and a pulse oximeter. If the patient reported symptoms, a cardiologist would perform a remote clinical assessment before referring them to the ED, their primary care physician or elsewhere. Data were collected at three, six and nine months.

The primary outcome of time to first readmission at six months was lower in the telemedicine arm than the standard care arm (13 patients vs. 48 patients, respectively; hazard ratio [HR], 0.24; 95% CI, 0.13-0.44; p<0.001), using an intention-to-treat analysis.

Looking at secondary endpoints, ED admission was also lower in the telemedicine arm vs. standard care arm (40 vs. 62 patients; HR, 0.59; 95% CI, 0.40-0.89; p=0.01), Specifically, there were fewer unplanned coronary revascularizations (3% vs. 9%), fewer occurrences of chest pain (9% vs. 24%), and less breathlessness (21% vs. 39%) and dizziness (6% vs. 18%).

Study authors Nasser S. Alshahrani, MSc, et al., noted a sustained benefit was found at nine months, with an HR of 0.35 for event-free survival, compared with 0.24 at six months. Two patients in each group died during the nine-month follow-up. In the telemedicine vs. standard care arm, a myocardial infarction occurred in 11 and 37 patients (15% absolute reduction), respectively, and a stroke in three vs. eight patients.

"These results highlight the potential of telemedicine to improve post-ACS patient care by enhancing clinical decision-making and reducing the need for hospital care," Alshahrani, et al., concluded. Furthermore, they note, "it is also important for this protocol to be robust enough to prevent inappropriate readmissions and avoid in-person assessment."