Pharmacist-led, digitally enabled transitional care after acute myocardial infarction: design and baseline characteristics of the AMI-HOPE nationwide stepped-wedge trial.

Abstract

Aims: To describe the design of AMI-HOPE, a pharmacist-led, digitally enabled transitional care intervention for patients after acute myocardial infarction (AMI), and its nationwide stepped-wedge cluster-randomized evaluation across Singapore's public healthcare system.

Methods and results: AMI-HOPE is designed as a pragmatic, open-label trial across three health clusters (7 hospitals, 18 polyclinics) in which hospitals crossed over from standard cardiologist-led care to intervention at 3 month intervals. We utilize the Health Discovery+ (HD+) platform for remote vital signs monitoring, rule-based alerts, pharmacist-led teleconsultations, and automated patient education. Target N = 1512 (1:1 ratio); primary outcome is a hierarchical win ratio composite (CV death, MI, stroke, CV readmissions, low-density lipoprotein cholesterol, systolic blood pressure, HbA1c, patient-reported outcome measures). Secondary outcomes include guideline-directed medical therapy titration/adherence, LVEF, and cost-effectiveness. Enrolment completed in September 2025 (N = 1634 randomized; 810 control, 824 intervention). Baseline characteristics (N = 1492 in follow-up) showed a median age of 59 years, 12% female, 61% Chinese ethnicity. Twelve-month follow-up will complete on 30 September 2026.

Conclusion: AMI-HOPE demonstrates a scalable, digitally enabled model shifting early post-AMI care from specialist-led clinics to pharmacists with remote monitoring. This nationwide trial evaluates its clinical efficacy, implementation, and value at population scale. ClinicalTrials.gov: NCT07443982.