Long-term impact of telemedicine for lipid control after an acute coronary syndrome

Abstract Aims Lipid control is a pivotal measure for secondary prevention following an acute coronary syndrome (ACS). However, current registries indicate that only a small proportion of patients achieve the target LDL cholesterol (LDL-c) levels. Telemedicine is increasingly used, particularly in post-ACS management. We aimed to assess the long-term impact of a telemedicine-based strategy for lipid control following ACS. Methods This prospective study consecutively enrolled patients with ACS. All patients were discharged on high-intensity statins, and their lipid profiles were assessed one month later. At that point, patients were contacted by phone, and treatment was adjusted according to the therapeutic algorithm of the Spanish Society of Cardiology. Follow-up calls continued monthly until LDL-c 55 mg/dL was achieved. Results A total of 344 patients (mean age 67.3±12.4years, 32%women) were included. Baseline LDL-c was 108.4±40.7mg/dL, decreasing to 48.7 ± 14.4 mg/dL post-intervention. LDL-c 55mg/dL was achieved in 82.6% of patients, with an average treatment optimization time of 3.2±2.1 months. After a median follow-up of 39±10 months, 43 patients (12.5%) had died, and 72 (20.9%) experienced a 4P-MACE event. In multivariate analysis, LDL-c at the end of follow-up was independently associated with higher cardiovascular mortality (HR 1.04, 95%CI 1.01–1.08, p0.024), along with age (HR 1.09, 95%CI 1.02–1.16, p0.004) and previous coronary artery disease (HR 4,21 95%CI 1.18-14.9, p0.02). Conclusion A telemedicine-based intensive lipid-lowering strategy effectively optimized LDL-c levels and was associated with reduced cardiovascular mortality in a high-risk secondary prevention cohort.