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NCT07171580

Tailoring Post Discharge - Remote Education and Access for Cardiac Health

Sponsor: St. Boniface Hospital

View on ClinicalTrials.gov

Summary

Heart attacks are one of the top causes of death in Canada, with over 2,100 cases treated each year in Manitoba. Even though hospital care has improved, the period after going home is still risky. Many patients feel anxious and unsure about their recovery, and without enough support, they often end up back in the emergency department (ED). This is an even bigger challenge for people in rural areas, where getting follow-up care can be much harder. Filling these gaps is important to help patients get better and to reduce stress on the healthcare system. In a previous study, the investigators found that extra support made a big difference: only 8% of participants using a digital health tool returned to the ED within 30 days, compared to 22% of participants without it. Now, the investigators want to expand this study across Manitoba to see if digital health tools can help more people recover safely at home. The investigators will compare two types of follow-up care: education only versus education with extra support (like symptom tracking and virtual appointments). The investigators will look at how this affects hospital visits, mental well-being, and healthcare costs. The goal is to create a better support system for people after a heart attack, leading to healthier recoveries, less strain on hospitals, and better care for Manitobans - no matter where they live.

Official title: TPD-REACH: Tailoring Post Discharge - Remote Education and Access for Cardiac Health

Key Details

Gender

All

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

300

Start Date

2025-12-01

Completion Date

2027-04-30

Last Updated

2025-09-12

Healthy Volunteers

Conditions

Acute Coronary Syndrome Myocardial Infarction (MI)

Interventions

OTHER

Remote Home Monitoring - Education

A virtual platform will be used to provide education to ACS patients post discharge.

OTHER

Remote Home Monitoring - Education and Support

A virtual platform will be used to provide education and support to ACS patients post discharge.

Inclusion Criteria: \>18 years old, type 1 myocardial infarction27, resident of Manitoba Exclusion Criteria: Patients unable to consent or fully participate in the study due to: 1. Technology barriers 1. Lack of digital device, internet access or data 2. Discomfort with using technology 2. Communication or language barriers preventing participation 3. Cognitive or mental health limiting informed consent or participation 1. Dementia or cognitive impairment 2. Active or severe psychosis or other significant mental health conditions c. Active substance abuse 4. High-risk ACS where patients require more frequent or in person visits a. Cardiac: i. Coronary * Unrevascularizedleftmainormultivessellargeepicardialcoronary artery disease (\>2.5mm) * Coronary artery bypass surgery (CABG) during index hospitalization ii. Arrhythmias * Cardiac arrest during index event/hospitalization (ventricular tachycardia (VT)/ventricular fibrillation (VF), pulseless electrical activity (PEA)) iii. Cardiomyopathy * Left ventricular ejection fraction (LVEF) \<35% (most recent EF assessment) * Cardiogenic shock requiring pressors/inotropes for more than 24 hours * Requiring intubation/positive pressure ventilation/hi-flow oxygen for more than 24 hours * Switchedfromintravenous(IV)tooral(PO)loopdiureticwithinlast 48 hours * Change in PO loop diuretic dose within last 48 homes (home re- start of 80mg or less is allowed) * B-type natriuretic peptide (BNP) did not reduce by 30% iv. Cardiac Care Unit (CCU)/Intensive Care Unit (ICU) o Any CCU/ICU stay for more than 24 hours b. Medical: i. any condition with prognosis less than 1 year or a high LACE (Length of stay, Acuity of admission, Comorbidities, Emergency department use) score (\>15)28 ii. any medical comorbidity requiring in-person assessment within 2 weeks TPD-REACH PROTOCOL v3 29Aug2025 8 of 17 TPD-REACH: Remote Education and Access for Cardiac Health iii. transition to an alternative living arrangement/compromised independent living iv. need medication adjustment or investigation within 2 weeks c. Social: i. severe financial strain ii. no fixed address or housing instability iii. severe food insecurity iv. significant hearing or vision impairment v. poor health literacy While we aim to promote health equity, patients facing these challenges need more support than this project can offer and should be connected to appropriate services before discharge. 5. Non-atherosclerotic causes of ACS (spontaneous coronary artery dissection, stress- induced cardiomyopathy, myocarditis) as the education and treatment is different 6. Any additional factor preventing full participation in the study

Locations (1)

St Boniface Hospital

Winnipeg, Manitoba, Canada