1.01.05 2024:05:17 12:35:38.456 heart attack 495219 10599 1 1 1 NCT05654389 Model of Care The New Model of Care, Hail Health Cluster OTHER_GOV Effectiveness of Teleconsultation in Referring a Patient With Early Myocardial Infarction From Peripheral Hospital to Cardiac Centre in Hail, Saudi Arabia Effectiveness of a New Pathway of Referring a Patient With Early Myocardial Infarction From Peripheral Hospital to Cardiac Centre in Hail, Saudi Arabia: A Randomized Clustered Trial Telehealth December 2022 Not yet recruiting No January 2023 Anticipated June 2023 Anticipated July 2023 Anticipated December 7, 2022 December 15, 2022 December 16, 2022 Actual December 27, 2022 December 28, 2022 Actual Sponsor The New Model of Care, Hail Health Cluster OTHER_GOV Health Holding Company, Hail Health Cluster, Saudi Arabia UNKNOWN No No No The goal of this pragmatic trial is to test the benefit of using a teleconsultation for referring a patient with a heart attack at an early stage from the suburban hospital to the heart centre. A teleconsultation with an expert cardiologist will be conducted by the physician at a suburban hospital. The main questions it aims to answer are: To what extent does the use of a teleconsultation for a patient with a heart attack work well in lowering the proportion of deaths among patients with heart attacks who will be referred from suburban hospitals to the heart centre? To what extent does the use of a teleconsultation for a patient with a heart attack work well in raising the proportion of stable cases with heart attacks who will be referred from suburban hospitals to the heart centre? Participants will be asked to participate in a teleconsultation referral pathway from the suburban hospital to the heart centre. Researchers will compare the change in the proportion of death rate and survivors or stable cases in the intervention versus the control group during referral from suburban hospital to heart centre. Making use of telehealth and smart applications will positively improve the quality of the provided health service at suburban hospitals where there is a limited number of specialized doctors. The economic burden of myocardial infarction is the highest in Saudi Arabia. This burden is mainly due to the associated costs of medical interventions and the length of hospital stay. It is advisable that the health system in Saudi Arabia deploy appropriate measures for the prevention and early detection of myocardial infarction among diabetic patients. Otherwise, the economic burden of cardiovascular diseases is expected to shoot up. A practical approach for referring patients with Myocardial Infarction (MI) is the modified meta-plan methodology for refereeing a patient from primary care to a cardiology clinic. This approach is recommended as an additional practical pathway for a patient with cardiovascular disease in primary care. A concentrated value assessment model (CVAM) for determining percutaneous coronary intervention (PCI) levels is suggested to predict MI using accumulated sessions of ECG observation. Patients at high risk of future myocardial infarction could be identified by every optician at the eye clinic using retinal images and demographic data, Research Questions: To what extent does the use of a teleconsultation intervention is effective in reducing the proportion of deaths among patients with myocardial infarction who will be referred from peripheral hospital to the cardiac centre? To what extent does the use of teleconsultation is effective in increasing the proportion of stable cases with myocardial infarction who will be referred from the peripheral hospital to the cardiac centre? General objective: To estimate the effectiveness of using a teleconsultation for patients with myocardial infarction at peripheral hospitals in reducing the proportion of deaths and increasing the proportion of stable cases among referral cases. Specific Objectives: Aim 1: To compare the proportion of death among cases with myocardial infarction who will be referred from a peripheral hospital to the cardiac centre in the intervention versus the control group (routine care). Aim 2: To compare the proportion of stable cases of myocardial infarction who will be referred from the peripheral hospital to the cardiac centre in the intervention versus the control group (routine care). Aim 3: To compare the proportion of cases who developed co-morbidities such as heart failure in the intervention versus the control group (routine care). Literature Review: A positive protective effect of antidepressant use to protect against developing myocardial infarction as primary care intervention is evident. Research Design and Methods: This is a six months clustered randomized trial that will recruit patients with provisional a diagnosis of myocardial infarction at a governmental peripheral hospital in Hail city. Participants (P): The participants will be adults presented to the physician at the peripheral hospital with symptoms and signs of myocardial infarction. The participants are expected to be adults aged 18 years and above. Children and young adults will be excluded. The aim is to report eligible cases by the physician at the peripheral hospital upon satisfaction with the written criteria for early MI diagnosis. The reporting will continue for six months from the beginning of the trial. Cases in both intervention and control clusters will be notified and reported regularly. Telemedicine telemedicine Interventional Not Applicable Randomized Parallel Assignment Other None (Open Label) 440 Anticipated Application of teleconsultation using WhatsApp to refer patient with with myocardial infarction Experimental Application of teleconsultation using WhatsApp for a patient with myocardial infarction with a provisional diagnosis of myocardial infarction during referral from a district hospital to a cardiac centre. Other: Application of teleconsultation for a patient with a provisional diagnosis of myocardial infarction at the district hospital Routine care and handling of a patient with mycardial infarction at peripheral hospital No Intervention Routine care and consultation received by a patient with a provisional diagnosis of myocardial infarction during referral from the district hospital to the cardiac centre Other Application of teleconsultation for a patient with a provisional diagnosis of myocardial infarction at the district hospital Using teleconsultation for a patient with a provisional diagnosis of myocardial infarction during referral from the district hospital to the cardiac centre Application of teleconsultation using WhatsApp to refer patient with with myocardial infarction The proportion of death among patients with myocardial infarction who will be referred from the peripheral hospital to the cardiac centre The proportion of death among patients with myocardial infarction who will be referred from the peripheral hospital to the cardiac centre in the intervention versus the control group (routine care). 6 month from the start of the study The proportion of stable cases of myocardial infarction who will be referred from the peripheral hospital to the cardiac centre The proportion of stable cases of myocardial infarction who will be referred from the peripheral hospital to the cardiac centre in the intervention versus the control group (routine care). 6 month from the start of the study The proportion of stable cases of myocardial infarction who received Tissue Plasminogen Activator (TBA) before referral The proportion of stable cases of myocardial infarction who received Tissue Plasminogen Activator (TBA) before referral from the peripheral hospital to the cardiac centre in the intervention group versus the control group (routine care). 6 months after the start of the study The proportion of stable cases of myocardial infarction who developed co-morbidities The proportion of stable cases of myocardial infarction who developed co-morbidities such as heart failure in the intervention versus the control group (routine care). 6 months after the start of the study Inclusion Criteria: patient aged 18 to 80 with provisional diagnose of MI Exclusion Criteria: severely ill patient and patient with other chronic conditions or cancer Accepts Healthy Volunteers All 18 Years 60 Years Adult Fakhralddin Elfakki, Researcher at MOC Contact +966530855161 abbasfakhraddin@gmail.com Marwa Mahmoud Mahdy, CSoC Lead Contact +966508258235 maroo_79@hotmail.com Khalil Alshammari, VIP Chief MO Hail Health Cluster Study Chair Fakhralddin Elfakki, Researcher at MOC New Model of Care, Hail Health Cluser Principal Investigator Meshari Aljamani, MOC Lead New Model of Care, Hail Health Cluster Study Director No May 17, 2024 D000009203 Myocardial Infarction D000007238 Infarction D000007511 Ischemia D000010335 Pathologic Processes D000009336 Necrosis D000017202 Myocardial Ischemia D000006331 Heart Diseases D000002318 Cardiovascular Diseases D000014652 Vascular Diseases M12155 Myocardial Infarction Myocardial Infarction high M10282 Infarction Infarction high M10543 Ischemia low M12284 Necrosis low M6546 Coronary Artery Disease low M19506 Myocardial Ischemia low M9419 Heart Diseases low M17400 Vascular Diseases low BC14 Heart and Blood Diseases BC23 Symptoms and General Pathology All All Conditions