(CCSP012) EARLY SUCCESS OF THE TAILORING POST DISCHARGE PROGRAM (TPD) INDICATES FEASIBILITY AND SAFETY OF EARLY DISCHARGE FOR LOW-RISK ACS PATIENTS: A MANITOBA ACS NETWORK INITIATIVE

Background: Hospital discharge for acute coronary syndrome (ACS) patients is a complex process requiring careful assessment, coordination, and planning for a patient’s safe transition home. Poorly coordinated discharge planning, lack of communication with outpatient providers, inadequate risk assessment prior to discharge, or insufficient patient education for self-management often results in repeat emergency room (ER) visits and re-admission, which can create increased patient anxiety, delays in their return to work, and may be associated with poor outcomes. The purpose of the Tailoring Post Discharge Program (TPD) is to address these issues and safely transition ACS patients from hospital to home while providing education and support for improved outcomes.

METHODS AND RESULTS: Phase one of the TPD study compares the safety and efficacy of two different methods of early discharge for low-risk ACS patients: in-person Rapid Response Nursing (RRN) support and online Remote Home Monitoring (RHM) support. Both programs provide patients with extensive education, symptom support, and scheduled contact with health care providers during their first 2-weeks post hospital discharge.

Between February–April 2023, ACS patients were assessed using a risk assessment tool developed for this study utilizing cardiac, medical, community, and patient risks (Figure 1). Eligible patients were enrolled into RRN or RHM arm using a 1:1 randomization strategy. Clinical outcomes of mortality, repeat myocardial infarction, congestive heart failure, unplanned revascularization, re-hospitalization, and ER visits at 30 days post-discharge (for those applicable) were collected.

A total of 38 patients were approached: 2 patients were excluded for not meeting criteria (lives outside Winnipeg n=1 and high risk n=1), 4 patients refused (too overwhelming n=1, not comfortable with technology n=1, no time to participate n=1, no devices or internet n=1), 7 patients consented to the registry, and 25 patients were enrolled in the full study.

The enrolment rate was 66%. Patient baseline demographics are shown in Table 1. Initial data indicates that STEMI patients enrolled in the interventions were discharged 34.04 hours earlier (30.09 median hours), while NSTEMI patients were discharged 17.29 hours earlier (34.88 median hours) compared to low-risk ACS patients in historical control groups (64.13 and 52.17 median hours, respectively). At time of abstract, the number of available 30-day outcomes was 18 (RRN=9, RHM=9): 2 ER visits were observed in the RRN arm and no events in the RHM arm.

Conclusion: Preliminary analysis of the first 9 weeks of the TPD Study shows a promising uptake of early discharge interventions and transition of care.