Acute Myocardial Infarction (AMI)
Conditions
Brief summary
The Acute Myocardial Infarction - allied Health Oriented, Patient centered, and digitally Enabled care (AMI-HOPE) program is a model of care designed to improve post-AMI well-being, safety, and outcomes through greater involvement of AHPs in patient care and integrating digital technologies into routine primary care disease management. AMI-HOPE aims to deliver solutions to these identified gaps of care which will transform healthcare planning both at cluster and national levels. The cornerstone of the AMI-HOPE program will be upskilling pharmacists to take on low-intermediate complexity clinician roles during the post-discharge period. The first 6 months will be anchored by tertiary care before a handoff to primary care. This frees up cardiologists to focus on high complexity cases.
Detailed description
The AMI-HOPE program addresses three critical healthcare challenges: insufficient specialist capacity, limited outpatient clinic infrastructure, and excessive dependence on hospital-based rather than community-based care during the vulnerable early post-discharge period for myocardial infarction patients. The program trains pharmacists to provide comprehensive post-MI (Myocardial Infarction) care through personalized cardiovascular medication optimization, targeted interventions for patients with reduced ejection fraction, smoking cessation support, and lifestyle counseling covering diet and exercise. Care delivery occurs remotely through integrated digital health platforms that facilitate continuous vital signs monitoring, deliver structured patient education at strategic intervals, and promote effective self-management capabilities. This proof-of-value stepped-wedge pragmatic trial that evaluates the effectiveness of the AMI-HOPE intervention is conducted across seven hospitals and eighteen primary care polyclinics spanning Singapore's three health clusters.
Interventions
OTHERStandard of Care (SOC)
Standard of care treatment without the pharmacist-led digital platform assisted care
OTHERPharmacist-led digital platform assisted care
Up titration of medications by pharmacist. AMI-HOPE centers around a digital platform that offers continuous telemonitoring on patients' vitals, tailored medication prescription with support from pharmacists and personalised lifestyle nudges and educational material.
Sponsors
National University Heart Centre, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Step Wedge Trial
Eligibility
Sex/Gender
ALL
Age
21 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Male or Female, aged 21 to 90 years (inclusive), at the time of signing the informed consent form * Clinically diagnosed with AMI during index hospitalisation * Own a mobile phone with internet access- intervention arm only
Exclusion criteria
* Patients who are planned for palliative care or life expectancy \<1 year * Foreigners who do not have Singaporean citizenship/ Permanent Resident (PR) status * Patients who are enrolled into Healthier SG affiliated with General Practitioners (GPs) * Allergy or intolerance of Angiotensin-Converting Enzyme Inhibitors (ACE-I) or Angiotensin II Receptor Blockers (ARB)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Death and Unplanned Cardiovascular Disease (CVD) related (non-fatal MI, non-fatal stroke, others) rehospitalizations | between enrolment and end of 12-month follow up | Counts and time to any events of death or unplanned CVD related rehospitalizations |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Absolute change in concentration of Low-Density Lipoprotein Cholesterol (LDL-C) | between enrolment and end of 12-month follow up | Absolute change in LDL-C (in mmol/L) from enrollment to end of 12 month follow up period |
| Change in Blood Pressure (BP) | At discharge, 2 week, 1, 3, 6, 9 &12 months | Absolute change in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (in mmHg) from enrollment to end of 12 month follow up period |
| Change in Haemoglobin A1c (HbA1c) | between enrolment and end of 12-month follow up | Absolute change in HbA1c (in %) from enrollment to end of 12 month follow up period |
| EuroQoL (Quality of Life)-5 Dimensions (EQ-5D) Scores in Participants | At 1 month and 12 month | EQ-5D was calculated to evaluate quality of life (QoL) in participants. EQ-5D is a participant answered questionnaire scoring 5 dimensions - mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ-5D total score ranges from 0 (worst health state) to 1 (perfect health state) and 1 reflects the best outcome. |
| Patient Activation Measure (PAM-13) Scores in Participants | At discharge and 6month | The Patient Activation Measure 13 (PAM-13) is a non-disease-specific survey that assesses a patient's knowledge, skills, and confidence for self-management. It uses 13 items on a 4-point Likert scale, with the raw sum score (ranging from 13-52) being transformed into a standardized 0-100 metric. |
| Seattle Angina Questionnaire-7 (SAQ-7) Scores in Participants | At 1 month and 12 month | The change from baseline in Health-Related Quality of Life (HRQOL) is assessed by the SAQ-7. The SAQ-7 is a validated tool assessing three domains: physical limitation, angina frequency, and quality of life. An overall summary score is calculated by averaging the three domain scores (0-100), where higher scores indicate better health status (i.e., less frequent angina, better function, and higher quality of life). |
| Patient Health Questionnaire-9 (PHQ-9) Scores in Participants | At 1month and 12 month | The PHQ-9 is a validated 9-item self-report instrument used for screening and assessing the severity of depression. Each item is scored from 0 ("not at all") to 3 ("nearly every day") based on symptom frequency over the past two weeks, yielding a total score from 0 to 27, with higher scores indicating greater depression severity. |
| Presence of angina pectoris as determined by the Rose Angina Questionnaire | At 1month and 12month | The Rose Angina Questionnaire is a standardized, validated set of questions used to identify the presence of angina pectoris in epidemiological studies. It consists of a structured interview algorithm that classifies participants based on their responses to questions about chest pain characteristics, leading to a categorical outcome (e.g., definite angina, possible angina, or no angina). |
| Dose of ACE/ARB/MRA inhibitor | At discharge, 1, 3, 6 &12 months | Change in drug intensity score for ACE inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACE I/ARB/ARNI) and beta blockers, to assess the effect of the pharmacist led intervention on prescription, early up titration, and adherence to drugs, and the subsequent impact on LDL C, blood pressure, HbA1c control, and left ventricular ejection fraction (LVEF). |
| Percentage of patients smoking | At 1,3, 6 & 12 month | Each patient would be asked to indicate whether they are currently an active smoker(yes/no) at each point of assessment (at 1,3, 6 \& 12 month). The change in percentage of active smoker in the duration of the programme is use to assess the effectiveness of the smoking cessation programme. |
| Length of stay | Baseline | To assess the clinical efficiency of the intervention |
Countries
Singapore
Contacts
PRINCIPAL_INVESTIGATORMark Chan
National University Heart Centre, Singapore
Outcome results
None listed