Effectiveness of advanced practice nurse-led telehealth on readmissions and health-related outcomes among patients with post-acute myocardial infarction: ALTRA Study Protocol

Abstract

Aim: To develop and examine the effectiveness of an advanced practice nurse-led telehealth rehabilitative programme as a transitional nursing therapeutic on readmission rates and health-related outcomes among patients with acute myocardial infarction postdischarge.

Background: Patients suffering from acute myocardial infarction are experiencing an increasing trend of frequent readmissions. This implicates both the effectiveness of healthcare services and patient's quality of life. Advanced Practice Nurse-led telehealth rehabilitative programme has yet to be explored as a strategy to minimize preventable readmissions and improve patient's self-efficacy so as to enhance quality of life after a heart attack.

Design: Randomized controlled trial with repeated measures.

Methodology: A consecutive sampling of 172 patients with acute myocardial infarction will be recruited from a tertiary acute hospital in Singapore. Participants will be randomized into two groups. The experimental group (ALTRA) will receive Advanced Practice Nurse-led telehealth rehabilitative programme on discharge. The control group will receive only standard follow-up care. The outcome measures include readmissions, cardiac self-efficacy, cardiovascular risk factors, quality of life, anxiety and depression. The data will be collected at the baseline, 1 and 6 month postdischarge. A postprogramme evaluation will be conducted among the participants to assess its acceptability, strengths and weakness.

Discussion: ALTRA aims to engage and support patients with acute myocardial infarction by increasing self-care management through education and telehealth contacts with Advanced Practices Nurses. This provides a smoother transition of illness to health and ultimately, reduces preventable costly readmissions.

Trial registration: The study has been registered with clinicaltrials.gov. The trial registration number is NCT02483494.

Keywords: advanced practice nurse; cardiac rehabilitation; health-related outcomes; postacute myocardial infarction; readmissions; telehealth.