Remote monitoring successfully replaced some visits in post-MI care, study finds

Use of smart technology yields similar percentages of patients with controlled blood pressure after a heart attack compared with the standard of care, a study found.

Researchers conducted an investigator-initiated, single-center, nonblinded randomized clinical trial in The Netherlands to examine blood pressure control among 200 patients, 78% men, who had had either ST-segment elevation myocardial infarction or non-ST-segment acute coronary syndrome. Half the patients were randomized to regular care, including four in-person outpatient clinic visits in the year following the initial event. In the intervention group, patients were given four smartphone-compatible devices: a scale, a blood pressure monitor, a heart rhythm monitor, and a step counter. Two in-person outpatient clinic visits were replaced by electronic visits.

The primary outcome was blood pressure control, defined as a systolic blood pressure of 139 mm Hg or lower and a diastolic blood pressure of 89 mm Hg or lower. Secondary outcomes included patient satisfaction as determined by the Patient's Satisfaction Questionnaire, measurement adherence, all-cause mortality, and hospitalizations for nonfatal adverse cardiac events. Results were published April 16 by JAMA Network Open.

After one year, 79% of patients in the intervention group had controlled blood pressure compared to 76% of patients in the control group (P=0.64). General satisfaction with care was the same between groups (mean scores, 82.6 vs. 82.0; P=0.88). The all-cause mortality rate was 2% in both groups (P>0.99). Twenty hospitalizations for nonfatal adverse cardiac events occurred, eight in the intervention group and 12 in the control group. Of all patients, 32% sent in measurements each week, with 63% sending data for more than 80% of the weeks they participated in the trial.

Ninety percent of patients in the intervention group were satisfied with the smart technology intervention. Satisfaction with individual devices was 88% for the blood pressure monitor, 88% for the weight scale, 4% for the step counter, and 89% for the rhythm monitor. Eighty percent of patients were satisfied with the e-visit, and of those who were not, technical problems were the primary reason.

The study authors noted that electronic health tools are often considered a way to increase quality and patient satisfaction with care by preventing disease instead of treating it, easing communication among health care practitioners, reducing test duplication, and having patients perform some of their own tests.

“Although these are rather general remarks, the results of this study support some of this theory: first, patients were able to measure their own [blood pressure], [electrocardiogram], and weight and transfer the data to the hospital without the presence or assistance of trained health care staff,” the authors wrote. “This enabled the replacement of 2 physical outpatient clinic visits with 2 digital outpatient clinic visits, which are time-saving for patients and can, therefore, increase satisfaction. This may help reduce societal costs, especially for patients who are working.”