Acute Myocardial Infarction - Allied Health-Oriented Patient-centered Digitally-Enabled Care (AMI-HOPE)

The Acute Myocardial Infarction - allied Health Oriented, Patient centered, and digitally Enabled care (AMI-HOPE) program is a model of care designed to improve post-AMI well-being, safety, and outcomes through greater involvement of AHPs in patient care and integrating digital technologies into routine primary care disease management. AMI-HOPE aims to deliver solutions to these identified gaps of care which will transform healthcare planning both at cluster and national levels. The cornerstone of the AMI-HOPE program will be upskilling pharmacists to take on low-intermediate complexity clinician roles during the post-discharge period. The first 6 months will be anchored by tertiary care before a handoff to primary care. This frees up cardiologists to focus on high complexity cases.

Study Overview

• Status: Active, not recruiting
• Conditions: Acute Myocardial Infarction (AMI)
• Intervention / Treatment: Other: Standard of Care (SOC); Other: Pharmacist-led digital platform assisted care

Detailed Description

The AMI-HOPE program addresses three critical healthcare challenges: insufficient specialist capacity, limited outpatient clinic infrastructure, and excessive dependence on hospital-based rather than community-based care during the vulnerable early post-discharge period for myocardial infarction patients. The program trains pharmacists to provide comprehensive post-MI (Myocardial Infarction) care through personalized cardiovascular medication optimization, targeted interventions for patients with reduced ejection fraction, smoking cessation support, and lifestyle counseling covering diet and exercise. Care delivery occurs remotely through integrated digital health platforms that facilitate continuous vital signs monitoring, deliver structured patient education at strategic intervals, and promote effective self-management capabilities.

This proof-of-value stepped-wedge pragmatic trial that evaluates the effectiveness of the AMI-HOPE intervention is conducted across seven hospitals and eighteen primary care polyclinics spanning Singapore's three health clusters.

• Study Type: Interventional
• Enrollment (Actual): 1633
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore
    • National Heart Centre Singapore (NHCS)
  • Singapore, Singapore
    • Changi General Hospital (CGH)
  • Singapore, Singapore
    • Khoo Teck Puat Hospital (KTPH)
  • Singapore, Singapore
    • National University Heart Centre, Singapore (NUHCS)
  • Singapore, Singapore
    • Ng Teng Fong General Hospital (NTFGH)
  • Singapore, Singapore
    • Tan Tock Seng Hospital (TTSH)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male or Female, aged 21 to 90 years (inclusive), at the time of signing the informed consent form
• Clinically diagnosed with AMI during index hospitalisation
• Own a mobile phone with internet access- intervention arm only

Exclusion Criteria:

• Patients who are planned for palliative care or life expectancy <1 year
• Foreigners who do not have Singaporean citizenship/ Permanent Resident (PR) status
• Patients who are enrolled into Healthier SG affiliated with General Practitioners (GPs)
• Allergy or intolerance of Angiotensin-Converting Enzyme Inhibitors (ACE-I) or Angiotensin II Receptor Blockers (ARB)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control; Standard of Care	Other: Standard of Care (SOC); Standard of care treatment without the pharmacist-led digital platform assisted care
Other: Pharmacist-led digital platform assisted care; AMI-HOPE centers around a digital platform that offers continuous telemonitoring on patients' vitals, tailored medication prescription with support from pharmacists, and personalised lifestyle nudges and educational material.	Other: Pharmacist-led digital platform assisted care; Up titration of medications by pharmacist. AMI-HOPE centers around a digital platform that offers continuous telemonitoring on patients' vitals, tailored medication prescription with support from pharmacists and personalised lifestyle nudges and educational material.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Death and Unplanned Cardiovascular Disease (CVD) related (non-fatal MI, non-fatal stroke, others) rehospitalizations	Counts and time to any events of death or unplanned CVD related rehospitalizations	between enrolment and end of 12-month follow up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute change in concentration of Low-Density Lipoprotein Cholesterol (LDL-C)	Absolute change in LDL-C (in mmol/L) from enrollment to end of 12 month follow up period	between enrolment and end of 12-month follow up
Change in Blood Pressure (BP)	Absolute change in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (in mmHg) from enrollment to end of 12 month follow up period	At discharge, 2 week, 1, 3, 6, 9 &12 months
Change in Haemoglobin A1c (HbA1c)	Absolute change in HbA1c (in %) from enrollment to end of 12 month follow up period	between enrolment and end of 12-month follow up
EuroQoL (Quality of Life)-5 Dimensions (EQ-5D) Scores in Participants	EQ-5D was calculated to evaluate quality of life (QoL) in participants. EQ-5D is a participant answered questionnaire scoring 5 dimensions - mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ-5D total score ranges from 0 (worst health state) to 1 (perfect health state) and 1 reflects the best outcome.	At 1 month and 12 month
Patient Activation Measure (PAM-13) Scores in Participants	The Patient Activation Measure 13 (PAM-13) is a non-disease-specific survey that assesses a patient's knowledge, skills, and confidence for self-management. It uses 13 items on a 4-point Likert scale, with the raw sum score (ranging from 13-52) being transformed into a standardized 0-100 metric.	At discharge and 6month
Seattle Angina Questionnaire-7 (SAQ-7) Scores in Participants	The change from baseline in Health-Related Quality of Life (HRQOL) is assessed by the SAQ-7. The SAQ-7 is a validated tool assessing three domains: physical limitation, angina frequency, and quality of life. An overall summary score is calculated by averaging the three domain scores (0-100), where higher scores indicate better health status (i.e., less frequent angina, better function, and higher quality of life).	At 1 month and 12 month
Patient Health Questionnaire-9 (PHQ-9) Scores in Participants	The PHQ-9 is a validated 9-item self-report instrument used for screening and assessing the severity of depression. Each item is scored from 0 ("not at all") to 3 ("nearly every day") based on symptom frequency over the past two weeks, yielding a total score from 0 to 27, with higher scores indicating greater depression severity.	At 1month and 12 month
Presence of angina pectoris as determined by the Rose Angina Questionnaire	The Rose Angina Questionnaire is a standardized, validated set of questions used to identify the presence of angina pectoris in epidemiological studies. It consists of a structured interview algorithm that classifies participants based on their responses to questions about chest pain characteristics, leading to a categorical outcome (e.g., definite angina, possible angina, or no angina).	At 1month and 12month
Dose of ACE/ARB/MRA inhibitor	Change in drug intensity score for ACE inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACE I/ARB/ARNI) and beta blockers, to assess the effect of the pharmacist led intervention on prescription, early up titration, and adherence to drugs, and the subsequent impact on LDL C, blood pressure, HbA1c control, and left ventricular ejection fraction (LVEF).	At discharge, 1, 3, 6 &12 months
Percentage of patients smoking	Each patient would be asked to indicate whether they are currently an active smoker(yes/no) at each point of assessment (at 1,3, 6 & 12 month). The change in percentage of active smoker in the duration of the programme is use to assess the effectiveness of the smoking cessation programme.	At 1,3, 6 & 12 month
Length of stay	To assess the clinical efficiency of the intervention	Baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost-effectiveness	Health benefits expressed in Quality-Adjusted Life Years (QALYs) and incremental cost-effectiveness ratio (ICER) as the incremental cost of intervention delivery divided by the incremental health outcome (QALYs gained), to assess cost-effectiveness	At the end of 12-month follow up

Collaborators and Investigators

• Sponsor: National University Heart Centre, Singapore
• Investigators: Principal Investigator: Mark Chan, National University Heart Centre, Singapore

Study record dates

Study Major Dates

• Study Start (Actual): January 11, 2023
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: February 1, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 25, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: PHRGTC-0003

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No