Can a smartphone app keep heart attack patients out of the ER?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: \>18 years old, type 1 myocardial infarction27, resident of Manitoba Exclusion Criteria: Patients unable to consent or fully participate in the study due to: 1. Technology barriers 1. Lack of digital device, internet access or data 2. Discomfort with using technology 2. Communication or language barriers preventing participation 3. Cognitive or mental health limiting informed consent or participation 1. Dementia or cognitive impairment 2. Active or severe psychosis or other significant mental health conditions c. Active substance abuse 4. High-risk ACS where patients require more frequent or in person visits a. Cardiac: i. Coronary * Unrevascularizedleftmainormultivessellargeepicardialcoronary artery disease (\>2.5mm) * Coronary artery bypass surgery (CABG) during index hospitalization ii. Arrhythmias * Cardiac arrest during index event/hospitalization (ventricular tachycardia (VT)/ventricular fibrillation (VF), pulseless electrical activity (PEA)) iii. Cardiomyopathy * Left ventricular ejection fraction (LVEF) \<35% (most recent EF assessment) * Cardiogenic shock requiring pressors/inotropes for more than 24 hours * Requiring intubation/positive pressure ventilation/hi-flow oxygen for more than 24 hours * Switchedfromintravenous(IV)tooral(PO)loopdiureticwithinlast 48 hours * Change in PO loop diuretic dose within last 48 homes (home re- start of 80mg or less is allowed) * B-type natriuretic peptide (BNP) did not reduce by 30% iv. Cardiac Care Unit (CCU)/Intensive Care Unit (ICU) o Any CCU/ICU stay for more than 24 hours b. Medical: i. any condition with prognosis less than 1 year or a high LACE (Length of stay, Acuity of admission, Comorbidities, Emergency department use) score (\>15)28 ii. any medical comorbidity requiring in-person assessment within 2 weeks TPD-REACH PROTOCOL v3 29Aug2025 8 of 17 TPD-REACH: Remote Education and Access for Cardiac Health iii. transition to an alternative living arrangement/compromised independent living iv. need medication adjustment or investigation within 2 weeks c. Social: i. severe financial strain ii. no fixed address or housing instability iii. severe food insecurity iv. significant hearing or vision impairment v. poor health literacy While we aim to promote health equity, patients facing these challenges need more support than this project can offer and should be connected to appropriate services before discharge. 5. Non-atherosclerotic causes of ACS (spontaneous coronary artery dissection, stress- induced cardiomyopathy, myocarditis) as the education and treatment is different 6. Any additional factor preventing full participation in the study