Impact of teleconsultation follow-up to control low-density-lipoprotein cholesterol at one year after acute coronary syndrome: the teleobjectif prospective cohort study

Abstract Context High level of low-density lipoprotein cholesterol (LDL-c) is one of the most important causal and independent risk factor for recurrent atheromatous cardiovascular events. Despite the availability of several treatments that can reduce LDL-c by up to 85%, less than 30% of patients achieve the LDL-c target < 0.55 g/dl, recommended by the European Society of Cardiology for secondary cardiovascular prevention. Aim We hypothesized that teleconsultation monitoring would allow better control of LDL-c blood levels at one year in a population after acute coronary syndrom (ACS). Methods This bi-centric prospective cohort study, conducted between december 2019 and december 2021, compared a group that received standard follow-up after an ACS with an interventional group that received regular follow-up by teleconsultation, in addition of usual care, to optimise lipid-lowering treatments. Results 1602 patients met the inclusion criteria for our study (814 in the usual care group and 788 in the teleconsultation group). The proportion of patients with LDL-c < 0.55 g/L at one year was statistically significant in the teleconsultation group (74.7%) compared with the usual care group (26.6%) (p<0.001). The average (standard deviation) absolute value of LDL-c at 1 year was 0.48 g/L (0.2) in the teleconsultation group and 0.75 g/L (0.32) in the usual care group (p<0.001). In the multivariate analysis, receiving teleconsultation follow-up made it more likely to achieve the LDL-c target (4.88 [4,09 ; 5,85], p<0.001). The use of lipid-lowering treatments, including statins, ezetimibe and anti-PCSK9 inhibitors was much higher in the teleconsultation group (p<0.001). There was a significant difference in overall survival (p=0.016) and cardiovascular survival (p=0.013) in favor of the teleconsultation group. Conclusion teleconsultation follow-up after ACS significantly improved lipid control and survival at one year.% patients achieving 1-year LDL-c targetOverall survival