Abstract

Background Unplanned re-admissions after acute coronary syndrome (ACS) remain high. Telemedicine programmes can provide remote diagnostic information to aid clinical decision that could optimize and reduce the need to access hospital care. Methods TELE-ACS is a randomized controlled trial comparing a telemedicine-based approach versus standard care in patients following ACS. Patients were suitable for inclusion with at least one cardiovascular risk factor and presenting with ACS and were randomized (1:1) prior to discharge. The primary outcome was the frequency of hospital readmissions 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. The trial was registered on ClinicalTrials.gov (NCT05015634). Results 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 to 0.44; p < 0.001) and ED attendance (HR 0.59; 95% CI 0.59; 95% CI 0.40 to 0.89) in the telemedicine arm, and fewer unplanned coronary revascularizations (3% in telemedicine arm versus 9% in standard therapy arm). The occurrence of chest pain (9% versus 24%), breathlessness (21% versus 39%) and dizziness (6% versus 18%) at 6-months was lower in the telemedicine group. Conclusions The TELE-ACS 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.