Telemedicine can cut readmission and boost outcomes for heart patients
A “simple strategy” involving the remote monitoring and assessment of patients after a heart attack can reduce hospital readmissions and improve outcomes, according to UK researchers.
They found patients who were managed through telemedicine were 76% less likely to be readmitted to hospital within six months than other patients.
“The findings suggest that telemedicine may have a significant role to play in freeing time and space in hospitals”
James Leiper
According to the study authors, the findings suggest that remote monitoring could help to tackle record waiting lists by easing pressures on NHS emergency departments and cardiology wards.
The study was presented earlier this month at the American College of Cardiology conference in Atlanta and also published in the Journal of the American College of Cardiology.
The approach involved patients sending their vital signs and calling specialist cardiology teams for a remote consultation when they experienced symptoms that sparked concern.
The study, led by researchers from Imperial College London, involved 337 patients who came to Hammersmith Hospital with acute coronary syndromes (ACS) over 15 months.
ACS is a group of life-threatening conditions that involve reduced blood flow to the heart, including heart attacks and unstable angina.
The majority of those in the study – 86% – were men, reflecting the demographics of the patients who attended Hammersmith Hospital’s heart attack centre with ACS during the study.
Patients in the trial were randomly assigned to receive either telemedicine or standard care, noted the researchers, who were funded by the charity the British Heart Foundation (BHF).
The 163 patients in the telemedicine group were provided with a blood pressure monitor and a pulse oximeter to measure blood oxygen levels.
They were also given a cutting-edge 12-lead electrocardiogram (ECG) belt device to record a detailed heart rhythm trace and transmit it to the specialist team for review.
The 167 patients who received standard care were discharged with medication and told to go to a doctor or hospital if they experienced heart symptoms.
Telemedicine patients were told to send in their data to the trial team if they experienced symptoms of a potential heart problem, after which they were contacted for a remote clinical assessment.
Seriousness was assessed using rules developed by the research team and the patient was either reassured, advised a non-urgent follow-up or advised to attend accident and emergency or call 999.
In the study, telemedicine patients were 76% less likely to be readmitted to hospital within six months and 41% were less likely to attend A&E compared to those who received the usual care.
Even for those who were readmitted to hospital, the average length of stay was half a day – much less than the average one and a half days in the standard care group, noted the ressearchers.
Telemedicine patients also had a 15% lower risk of repeat heart attacks after nine months, a lower number of unplanned surgical procedures on the blood vessels of the heart and a lower stroke rate.
In addition, data showed that telemedicine patients were less likely to report symptoms including chest pain, dizziness and shortness of breath.
The study was led by Dr Ramzi Khamis, consultant cardiologist and BHF research fellow at the National Heart and Lung Institute, Imperial College London.
He said: “The approach we designed and tested is focused on sparing valuable time and resources while reaching a well-informed treatment plan for high-risk patients experiencing worrying symptoms.
“The study clearly showed that sending vital information straight to cardiology teams, coupled with a consultation, led to seemingly better care, reductions in admissions, average length of stay and A&E attendance.
“We are now looking at working with the NHS and other healthcare systems globally to adopt this strategy and hopefully improve treatment for future patients,” he said.
Professor James Leiper, associate medical director at the BHF, described the results of the study as “very encouraging”.
“The findings suggest that telemedicine may have a significant role to play in freeing time and space in hospitals, whilst maintaining safety and even improving outcomes for at-risk patients,” he said.
He added: “Telemedicine could prove to be a valuable tool for clinicians to bring real improvements for patients during a difficult time in their lives.”
