title: Effectiveness of advanced practice nurse-led telehealth on readmissions and health-related outcomes among patients with post-acute myocardial infarction: ALTRA Study Protocol.
abstract: OBJECTIVE
  To develop and examine the effectiveness of an advanced practice nurse-led telehealth rehabilitative programme as a transitional nursing therapeutic on readmission rates and health-related outcomes among patients with acute myocardial infarction postdischarge.
  
  
  BACKGROUND
  Patients suffering from acute myocardial infarction are experiencing an increasing trend of frequent readmissions. This implicates both the effectiveness of healthcare services and patient's quality of life. Advanced Practice Nurse-led telehealth rehabilitative programme has yet to be explored as a strategy to minimize preventable readmissions and improve patient's self-efficacy so as to enhance quality of life after a heart attack.
  
  
  METHODS
  Randomized controlled trial with repeated measures.
  
  
  METHODS
  A consecutive sampling of 172 patients with acute myocardial infarction will be recruited from a tertiary acute hospital in Singapore. Participants will be randomized into two groups. The experimental group (ALTRA) will receive Advanced Practice Nurse-led telehealth rehabilitative programme on discharge. The control group will receive only standard follow-up care. The outcome measures include readmissions, cardiac self-efficacy, cardiovascular risk factors, quality of life, anxiety and depression. The data will be collected at the baseline, 1 and 6 month postdischarge. A postprogramme evaluation will be conducted among the participants to assess its acceptability, strengths and weakness.
  
  
  CONCLUSIONS
  ALTRA aims to engage and support patients with acute myocardial infarction by increasing self-care management through education and telehealth contacts with Advanced Practices Nurses. This provides a smoother transition of illness to health and ultimately, reduces preventable costly readmissions.
  
  
  BACKGROUND
  The study has been registered with clinicaltrials.gov. The trial registration number is NCT02483494.
authors.affiliation: National University Heart Centre Singapore, Singapore.|National University Health System, Singapore.|Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Karen Wei Ling
authors.initials: KW
authors.lastname: Koh
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Wenru
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.|Cardiovascular Research Institute, National University Health System, Singapore.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Karis Kin Fong
authors.initials: KK
authors.lastname: Cheng
mesh_terms: D006801:Humans; D009203:Myocardial Infarction / Q000451:nursing*; D010359:Patient Readmission; D011788:Quality of Life; D012307:Risk Factors; D012846:Singapore; D017216:Telemedicine
keywords: advanced practice nurse; cardiac rehabilitation; health-related outcomes; postacute myocardial infarction; readmissions; telehealth