Self-monitoring patterns after acute coronary syndrome: behavioural markers for secondary prevention

Abstract Background Sustained engagement is essential for remote monitoring (RM) after acute coronary syndrome (ACS), yet self-monitoring behaviour differs across patients and may influence risk-factor control and clinical outcomes. Objectives To assess whether previously identified adherence patterns could be reproduced in a larger cohort, whether healthcare worker outreach triggered by missing measurements (Medical Service Centre, MSC) was associated with more sustained adherence, and whether these patterns were associated with differences in secondary-prevention outcomes and clinical events. Methods In this retrospective cohort study, patients enrolled in a post-ACS RM programme at a tertiary centre were included. Weekly use of three home-monitoring devices over 12 months was grouped into adherence patterns using time-series k-means clustering. Patients were categorised by enrolment before or after implementation of MSC-supported care. Blood pressure, lipids, body mass index (BMI), target attainment and clinical events were analysed using generalized estimating equations. Results A total of 1181 patients were included. Three adherence patterns were identified and replicated, consistent with the patterns previously described as “loyally persisting”,” “temporarily persistent,” and “negligent quitting”. After MSC implementation, the distribution shifted toward more favourable patterns, with more loyally persisting patients (p < 0.001). This pattern showed more favourable cardiometabolic profiles and, for BMI, triglycerides and LDL-C target attainment greater improvement over time. Clinical event rates did not differ significantly between patterns, although directional trends favoured the loyally persisting pattern. Conclusions RM adherence patterns are reproducible and clinically meaningful after ACS, with potential value as behavioural markers for risk stratification and targeted support in secondary prevention.