Graduate Student University of Manitoba Winnipeg, Manitoba, Canada
Background: Hospital discharge for acute coronary syndrome (ACS) patients is a critical transition, often resulting in preventable patient anxiety, emergency department (ED) visits, and readmissions, due to delayed access to outpatient care and inadequate patient education. Often patients are unable to have a follow-up appointment with their primary healthcare provider until at least 2-4 weeks after discharge for their ACS, and it may take months before they see a cardiologist. ACS-24 is a transition of care program that aims to improves outcomes by providing structured post-discharge education and support for ACS patients.
METHODS AND RESULTS: The ACS-24 study compares two transition of care methods for low-risk ACS patients: in-person Rapid Response Nursing (RRN) and digital Remote Home Monitoring (RHM). Both approaches offer education, symptom support, and scheduled healthcare provider contact for the first two weeks post-discharge. Between February 2023 – April 2024, 104 eligible patients were randomized (1:1) into RRN or RHM. Key outcomes including mortality, repeat myocardial infarction, congestive heart failure, stroke, ED visits, and hospital readmissions were measured at 30 days post-discharge.
An interim analysis showed that ACS-24 participants (mean age of 59.6 ± 10.8, 80% male) were discharged significantly earlier than historical control groups (ST-elevation myocardial infarction patients: 26.7 vs 64.1 hours (p <.001), non ST-elevation myocardial infarction patients: 32.6 vs 52.2 hours (p <.001)), with similarly low readmission rates (4% for both, p=1.0). Notably, ACS-24 participants had fewer ED visits at 30 days compared to historical controls (14% vs 22%, p=.054), indicating a positive trend toward reducing unnecessary healthcare utilization. When stratified by intervention type, ED visits were significantly lower in the RHM group (8.2%, p=.015 vs historical controls), while rates in the RRN group were similar to historical controls (19.6%, p=.866). Additionally, participant feedback was overwhelmingly positive, reflecting both reassurance and high satisfaction with the support they received.
Conclusion: The ACS-24 program demonstrates the potential to meaningfully reduce ED visits and improve post-discharge care for low-risk ACS patients. Importantly, the program facilitates significantly earlier discharge without increasing readmission rates, supporting safe optimization of hospital resources. With expanded patient enrollment, we aim to confirm these findings and bring this approach to a wider population, helping hospitals province-wide with cost-effectiveness while improving patient care.
