Outcome of Telemedicine Compared With Traditional In-Person Follow-Up Visits in Patients With Acute Coronary Syndromes. Virtual Heart Study

Introduction: Telemedicine offers considerable opportunities to bring high-quality cardiovascular care. Its role in the ischemic-heart disease continuum in patients with acute coronary syndromes (ACS) has not been previously evaluated. Hypothesis: Virtual visits (VV) can be used as an alternative to in-person (IV) follow-up office visits in patients with ACS. Methods: 418 patients undergoing angiography for ACS (104 STEMI/314 NSTEMI) were randomized to follow-up via VV (n=208) using a free patient commercial platform or IV (n=210) between February and December 2020. Primary endpoints included major adverse cardiovascular events (MACE) at 1,6 and12 months and 1-year all-cause mortality. Secondary endpoints included 1-year adherence to guideline based-medical therapy including LDL-c < 70 mg/dl, dual antiplatelet therapy, beta-blockers, ACE/ARB/ARNI, Aldosterone antagonists for patients with EF<40%, participation in cardiac rehabilitation, cardiovascular-related hospitalization and all hospitalizations, and crossover between follow-up modalities. Follow-up was scheduled at 2,4,8,12 weeks after discharge and every 12 weeks afterward for one 1 year. Results: No significant difference was found in the demographics, procedural variables, baseline laboratories, ejection fraction, revascularization modalities, therapy at discharge, subjects lost-to-follow-up, missed, and rescheduled visits among study groups. MACE at 1-month [IV:1.9% Vs VV:1.4% (p =0.74)], 6-months [IV:6.7% Vs VV:5.8% (p =0.66)],12-months [IV:10.5% Vs VV: 10.6% (p =0.99)] and 1-year all-cause-mortality [IV:5.7% Vs VV: 6.7% (p =0.76)] was similar between groups. No significant difference was found between groups regarding all secondary endpoints including guideline-based medical therapy, participation in cardiac rehabilitation, CV-related death, and all hospitalization. The patients in the VV group had a higher incidence of crossover to IV visits at the end of the study [IV:5(2.4%)Vs VV:25(12%) (p < 0.01)]. Conclusions: Telemedicine can be a valuable tool in the follow-up care in patients with ACS during the first year after index hospitalization, resulting in similar outcomes compared with traditional in-person follow-up visits.