JMIR Publications

ABSTRACT

Background:

To maximize adherence to prescribed treatment and lifestyle, coronary heart disease (CHD) patients should be closely followed up after percutaneous coronary intervention (PCI). Concerning the spatial accessibility of patients, telemedical interventional management may improve better patient care by providing closer follow-up than usual care.

Objective:

This study was aimed to determine whether remote patient management directed by health professionals during secondary prevention would reduce clinical outcomes in CHD patients after PCI.

Methods:

In this investigator-initiated, open-label, randomized controlled trial, 2086 CHD patients aged between 18 and 79 (including 18 and 79) who had received PCI in The First Affiliated Hospital of University of Science and Technology of China between December 2022 and June 2023 were randomly assigned to the remote patient management (n=1040) or usual care (n=1046) group. The usual care group received follow-up calls by healthcare providers at 1, 3, 6, and 12 months after hospital discharge. The remote patient management group received multicomponent interventions delivered on a web-based platform in addition to usual care. The primary outcome was a composite of major adverse cardiac or cerebral events (MACCE, a composite of cardiac death, recurrent myocardial infarction, ischemia-driven target vessel revascularization or stroke) within one year after discharge.

Results:

During the one-year follow-up, 55 participants were found with MACCE (5.3%) in the usual care group while 36 MACCE (3.5%) in the remote patient management group. The difference was significant between the two groups (P=.044). This significance was mainly a consequence of reduction in cardiac death (1.0% vs 2.3%, P=.017) and myocardial infarction (0.8% vs 1.8%, P =.034) in the remote patient management group compared to the usual care group. Remote patient management was also associated with positive influence on blood-pressure, current drinking (11.7% vs16.5%, P=.002), adherence rates for heparin (87.8% vs 84.4%, P=.027), angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker/angiotensin receptor neprilysin inhibitor (47.9% vs 43.5%, P=.045) and also BARC 3-5 bleeding events (0.6% vs 1.6%, P=.033).

Conclusions:

A well-designed telemedical interventional management package could significantly reduce the risk of cardiovascular death or myocardial infarction in the secondary prevention among CHD patients. Further multicenter and randomized studies are warranted to assess the validity and efficacy of telemedical interventional management systems. Clinical Trial: registered with the Chinese Clinical Trial Registry, number ChiCTR2200065344.