{"id":"176d843075d8","type":"article","url":"https://hartvaat.nl/2021/07/01/remote-post-ontslag-behandeling-na-mi-door-paramedici-versus-standaardzorg-jama-/","title":"Remote post-ontslag behandeling na MI door paramedici versus standaardzorg: JAMA Cardiology","title_en":"Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction by Allied Health Care Practitioners vs Standard Care: The IMMACULATE Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.6721","source_url":"https://doi.org/10.1001/jamacardio.2020.6721","authors":["Mark Y Chan","Karen W L Koh","Sock-Cheng Poh","Stephanie Marchesseau","Devinder Singh","Yiying Han","Faclin Ng","Eleanor Lim","Joseph F Prabath","Chi-Hang Lee","Hui-Wen Sim","Ruth Chen","Leonardo Carvalho","Sock-Hwee Tan","Joshua P Y Loh","Jack W C Tan","Karishma Kuwelker","R M Amanullah","Chee-Tang Chin","James W L Yip","Choy-Yee Lee","Juvena Gan","Chew-Yong Lo","Hee-Hwa Ho","Derek J Hausenloy","Bee-Choo Tai","A Mark Richards"],"significance":6,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This trial showed that remote post-discharge treatment by allied health practitioners after MI achieves comparable safety and efficacy to standard cardiologist-led care, supporting task-shifting for post-MI management.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology trial naar remote post-ontslagbehandeling door paramedici versus standaardzorg na MI.","abstract_original":"IMPORTANCE: There are few data on remote postdischarge treatment of patients with acute myocardial infarction. OBJECTIVE: To compare the safety and efficacy of allied health care practitioner-led remote intensive management (RIM) with cardiologist-led standard care (SC). DESIGN, SETTING, AND PARTICIPANTS: This intention-to-treat feasibility trial randomized patients with acute myocardial infarction undergoing early revascularization and with N-terminal-pro-B-type natriuretic peptide concentration more than 300 pg/mL to RIM or SC across 3 hospitals in Singapore from July 8, 2015, to March 29, 2019. RIM participants underwent 6 months of remote consultations that included β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) dose adjustment by a centralized nurse practitioner team while SC participants were treated face-to-face by their cardiologists. MAIN OUTCOMES AND MEASURES: The primary safety end point was a composite of hypotension, bradycardia, hyperkalemia, or acute kidney injury requiring hospitalization. To assess the efficacy of RIM in dose adjustment of β-blockers and ACE-I/ARBs compared with SC, dose intensity scores were derived by converting comparable doses of different β-blockers and ACE-I/ARBs to a scale from 0 to 5. The primary efficacy end point was the 6-month indexed left ventricular end-systolic volume (LVESV) adjusted for baseline LVESV. RESULTS: Of 301 participants, 149 (49.5%) were randomized to RIM and 152 (50.5%) to SC. RIM and SC participants had similar mean (SD) age (55.3 [8.5] vs 54.7 [9.1] years), median (interquartile range) N-terminal-pro-B-type natriuretic peptide concentration (807 [524-1360] vs 819 [485-1320] pg/mL), mean (SD) baseline left ventricular ejection fraction (57.4% [11.1%] vs 58.1% [10.3%]), and mean (SD) indexed LVESV (32.4 [14.1] vs 30.6 [11.7] mL/m2); 15 patients [5.9%] had a left ventricular ejection fraction <40%. The primary safety end point occurred in 0 RIM vs 2 SC participants (1.4%) (P = .50). The mean β-blocker and ACE-I/ARB dose intensity score at 6 months was 3.03 vs 2.91 (adjusted mean difference, 0.12 [95% CI, -0.02 to 0.26; P = .10]) and 2.96 vs 2.77 (adjusted mean difference, 0.19 [95% CI, -0.02 to 0.40; P = .07]), respectively. The 6-month indexed LVESV was 28.9 vs 29.7 mL/m2 (adjusted mean difference, -0.80 mL/m2 [95% CI, -3.20 to 1.60; P = .51]). CONCLUSIONS AND RELEVANCE: Among low-risk patients with revascularization after myocardial infarction, RIM by allied health care professionals was feasible and safe. There were no differences in achieved medication doses or indices of left ventricular remodeling. Further studies of RIM in higher-risk cohorts are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02468349."}