HOPE: Pharmacists - The Allied Health-Oriented Patient-Centered and Technology-Enabled care for Acute Myocardial Infarction Patients

OBJECTIVES

To evaluate the effectiveness of pharmacist-led teleconsultations in improving CVRF and clinical outcomes among post-AMI patients across multiple hospitals.

MATERIALS AND METHODS

Post-AMI patients receiving pharmacist-led teleconsultations (intervention) were compared with usual standard-of-care (control). Primary outcomes included time-to-LDL-C <1.4 mmol/L, time-to-HbA1c <7%, proportions of patients attaining and sustaining these targets. Secondary outcomes included smoking cessation, readmissions, mortality and dose intensifications of medications. Time-to-event outcomes were analysed using Cox proportional hazards regression; binary outcomes using multivariable logistic regression adjusting for treatment group, age, sex, BMI, baseline values, comorbidities and hospital-site.

RESULTS

Of 1,509 patients with ≥6 months of follow-up (intervention n=712, control n=797), more intervention patients attained LDL-C <1.4 mmol/L (68.5% vs 38.6%; adjusted OR 6.90, 95% CI 4.87--9.77, p<0.001) with earlier target achievement (median 80 vs 180 days; adjusted HR 3.09, 95% CI 2.60--3.67, p<0.001). HbA1c <7% was achieved earlier (median 117 vs 148 days; adjusted HR 3.43, 95% CI 2.32--5.07, p<0.001) and at higher rates (70.3% vs 37.4%; adjusted OR 6.74, 95% CI 3.29--13.8, p<0.001). Smoking cessation was higher in intervention patients (41.0% vs 26.8%; adjusted OR 1.58, 95% CI 1.05--2.40, p=0.030). Readmissions were comparable at 6 months (28.0% vs 31.9%, p=0.406) but lower over full follow-up (33.0% vs 44.3%; adjusted OR 0.59, 95% CI 0.46--0.76, p<0.001), with no mortality difference (1.3% vs 2.4%, p=0.388). Dose intensification of ACEi/ARB/ARNi and BBs was significantly greater from 1 month onwards (all p≤0.004), corroborated by propensity score-matched sensitivity analyses (n=364 pairs).

CONCLUSION

Pharmacist-led teleconsultations significantly improved lipid-lowering target attainment, accelerated glycemic control, aided smoking cessation, and reduced long-term readmissions in post-AMI patients, supported by greater dose intensification of guideline-directed medications.