Remote Intensive Management by Allied Healthcare Providers Safe in Low-Risk MI Patients

By Reuters Staff

January 06, 2021

NEW YORK (Reuters Health) - Remote intensive management (RIM) led by allied healthcare practitioners is safe and feasible for patients with acute myocardial infarction (AMI) who undergo revascularization, a new randomized controlled trial shows.

Patients who were randomized to RIM by a centralized team of nurse practitioners achieved similar dose intensities of beta-blockers and angiotensin-converting-enzyme inhibitor/angiotensin-receptor blockers (ACE-I/ARB) compared with those who received in-person standard care (SC) from their cardiologists. And left ventricular remodeling was also similar for the two groups, Dr. Mark Y. Chan of the University of Singapore and colleagues found.

"Further studies of RIM in higher-risk cohorts are warranted," they conclude in JAMA Cardiology.

Beta-blockers and ACE-I/ARBs are recommended after AMI, but starting these medications and adjusting the dose can be difficult in the hospital, the authors note.

To investigate the effectiveness of remote management, they randomized 301 AMI patients at three Singapore hospitals to six months of RIM, including beta-blocker- and ACE-I/ARB-dose adjustment, or face-to-face visits with their cardiologist (SC). All had received early revascularization, and had N-terminal-pro-B-type natriuretic peptide concentrations above 300 ug/mL.

The study's primary safety endpoint - hypotension, bradycardia, hyperkalemia or acute kidney injury leading to hospitalization - occurred in none of the RIM group and in two SC patients (0% vs. 1.4%; P=0.50). At six months, the mean dose-intensity score for beta-blockers was 3.03 with RIM and 2.91 with SC (P=0.10), and 2.96 and 2.77 (P=0.07), respectively, with ACE-I/ARBs.

Indexed left ventricular end-systolic volume (LVESV) at six months was 28.9 mL/m2 with RIM and 29.7 mL/m2 with SC (P=0.51).

"This feasibility study demonstrates the potential for RIM to be tested on a higher-risk AMI population with reduced LVEF or heart failure," Dr. Chan and colleagues conclude.

SOURCE: https://bit.ly/3n7Lepy JAMA Cardiology, online December 30, 2020.

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