Recovering heart attack patients can be well cared for by highly trained experienced nurses supported by digital health tools, whose quality of care equals or even exceeds those provided by cardiologists.
These are the findings of a study involving 301 patients in three healthcare institutions in Singapore. Led by Associate Professor Mark Chan, Deputy Director of the Cardiovascular Disease Translational Research Programme at NUS Medicine and Senior Consultant at the National University Heart Centre, Singapore, the study showed that the nurse practitioners, equipped and supported by an array of digital health monitoring tools, were able to remotely monitor and assess the patients’ health daily as well as hold weekly consultations with them. Where necessary, the nurses also adjusted the patients’ medication doses, providing a level of care that Assoc Prof Chan and the team found was not usually available from busy cardiologists running heavy clinics.
THE NEED – CONTINUOUS MONITORING AND FREQUENT PERSONALIZED CARE INSTEAD OF LOW INTENSITY EPISODIC CARE
Heart attacks are common in Singapore where 10,000 new heart attacks occur each year. Death of heart muscle can be rapidly fatal and even among heart attack survivors, dead heart muscle can cause a lifetime of suffering by leading to heart failure.
The pre-hospital and in-hospital management of heart attacks in Singapore is considered among the best in the world, with our public hospitals offering 24/7 emergency angioplasty treatment to open up blocked arteries in double-quick time. However, challenges remain in the care of heart attack patients after they leave the hospital. Ideally, heart attack patients should be reviewed early after discharge as the early post-discharge period is when they are most vulnerable to complications from the heart attack. It is also the most opportune window to adjust their medications for rapid healing of heart muscle.
THE PROBLEM – DELAY IN POST-DISCHARGE FOLLOW-UP
Yet, the reality is that cardiologists in most healthcare systems around the world are unable to see heart attack patients within a month of discharge. The primary reason for this delay in post-discharge follow-up is due to the logistic challenge of accommodating frequent in-person visits at specialist outpatient clinics in the hospital.
MORE ATTENTIVE CARE FROM NURSE CLINICIANS ENABLED BY TECHNOLOGY
Through the use of remote monitoring devices, the allied health clinicians – experienced, senior nurses with master and doctorate degrees in advanced nursing care – were able to monitor the patients’ blood pressure and heart rate daily and consult weekly with the patients, a level of care that has never been possible in the traditional model of face-to-face care with busy cardiologists.
Assoc Prof Chan, principal investigator of the IMproving reModeling in Acute myoCardial infarction Using Live and Asynchronous TElemedicine (IMMACULATE) trial, explained that the trial results should reassure patients that nurses and pharmacists, can deliver as good if not better care than cardiologists. Assoc Prof Chan, a cardiologist himself who looks after heart attack patients, said that “time and again, research has shown that allied health colleagues with the right training do as well and sometimes better than cardiologists, at least when taking care of conditions that are of lower complexity and pathway-driven. The reasons for this are diverse but include, perhaps, greater willingness to follow evidence-based clinical protocols and perhaps greater empathy. Certainly, research has repeatedly shown that fewer variations in practice often lead to better patient outcomes for common conditions.”
Assoc Prof Chan and the same team of investigators spanning all three healthcare clusters are now embarking on a far more ambitious trial of 6,000 heart attack patients in partnership with the Ministry of Health (MOH), MOH Office for Healthcare Transformation (MOHT), Health Promotion Board (HPB), Institute for Digital Medicine (WisDM) and Integrated Health Information System (IHiS), in which more advanced digital tools are paired with wireless devices and wearables to enhance patients well-being.
