Acute Remote Medicine Based Assessment of High Risk Atherosclerosis Patients

Abstract

Although there have been significant advancements in medical and interventional therapies, myocardial infarction (MI) remains a major cause of death in the UK. Unplanned readmission rates in the UK are high despite a global trend towards short hospital stays post-MI, sitting at approximately 10% at 30 days post-discharge and even higher at 6 months. The 30-day mortality rate post-ACS in the US is 7.3%, with comparably high rates observed in Europe and the UK. The use of telemedicine technology can provide remote, clinically necessary, diagnostic information, thus eliminating the necessity for patients to visit the hospital. Telemonitoring could improve the management of post-ACS care and reduce the number of unexpected readmissions. Despite these potential benefits, there are considerable barriers to its implementation.

This thesis present four chapters discussing the impact and efficacy of home telemonitoring for cardiac patients post-ACS. I first used a systematic review and meta-analysis to investigate the existing research on the use of telemedicine for patient management post-ACS. Second, I designed and validated a clinical decision support system algorithm for the remote management of patients post-ACS in a nonhospital setting. Third, I conducted a randomised controlled trial (acronym: TELE-ACS) that used a specialised hybrid remote telemonitoring system to monitor patients following their hospital discharge post-ACS. Fourth, I conducted a 6-month cost-benefit analysis of the TELE-ACS protocol and assessed its impact on the health-related quality of life in patients following ACS.

The results demonstrate that a remote monitoring approach in combination with clinical decision algorithm protocol based on patient symptoms, 12-lead ECG data, BP levels, and oxygen saturation levels, significantly decreased the rate of hospital readmissions, emergency department visits, unplanned coronary revascularisations, and patient-reported symptoms for patients post-ACS. Therefore, the TELE-ACS protocol represents a financially viable approach to reducing readmissions in ACS patients.