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NCT Number: NCT04617834

Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients Implementation (E-VICTORS)

This pre-post study will evaluate the implementation of a cardiovascular telehealth platform, which will connect experts from the Wake Forest University Health Sciences (WFUHS) tertiary care center with Wilkes County Emergency Medical Services (WC-EMS) system, Wilkes Medical Center Emergency Department (ED), and The Wilkes County Health Department Public Health Community Clinic (PHCC) to improve cardiovascular care in this rural community.

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This study is active but is not currently recruiting participants.

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Key information

Conditions

Cardiovascular Diseases Acute Coronary Syndrome Heart Diseases Myocardial Ischemia Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

Wilkes County Emergency Medical Services, Wilkesboro, North Carolina, United States

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About this study

This program aims to improve cardiovascular care for patients in Wilkes County by implementing a cardiovascular telehealth program designed to; a) assist WC- EMS paramedics with the early risk stratification (electrocardiogram (EKG) interpretation, vital signs, and risk scores), treatment, and transportation destination decisions in patients with acute chest pain or dyspnea, b) support Wilkes Medical Center (WMC) Emergency Department (ED) providers (physicians and advanced practice clinicians) in the evaluation, management, and disposition of patients with acute cardiovascular symptoms, and c) provide consultative expertise to the Primary Health Care Centers (PHCC) for patients seen following an EMS or ED encounter for cardiovascular symptoms.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • age > 18 years at time of index encounter
  • Cardiovascular symptoms (chest discomfort or dyspnea consistent with possible ACS) as indicated by the treating provider

Exclusion criteria

  • Age <18
  • Traumatic chest pain
  • Dyspnea that is clearly from a non-cardiac etiology
  • Patients with hemodynamic instability SBP < 90 mmHg, HR>160 or <40 bpm
  • Patients requiring intubation/mechanical ventilation

Treatment and study plan

Quality Surveillance Data Collection

Other

Data will be retrospectively collected through EHR queries

Primary outcomes

  1. Number of Emergency Department (ED) utilization

    Time frame: baseline

    ED utilization among patients with cardiovascular symptoms will be defined as the total number of cardiovascular-related ED admissions divided by the total number of unique individual patients receiving cardiovascular care during the project period.

Secondary outcomes

  1. Number of Cardiovascular hospitalizations

    Time frame: Baseline

    Cardiovascular hospitalizations will be defined as an inpatient or observation admission for cardiovascular conditions or symptoms based on Current Procedures Terminology (CPT) and International Classification of Diseases (ICD) codes

  2. Number of Cardiovascular Inter-facility transfers

    Time frame: Baseline

    Cardiovascular Inter-facility transfers will be defined based on patients with cardiovascular symptoms or conditions transferred from Wilkes Medical Center (WMC) to another hospital.

  3. Number of 30-day cardiovascular Emergency Department (ED) re-admissions

    Time frame: day 30

    30-day cardiovascular ED re-admissions will be defined as any cardiovascular related ED admission occurring during the 30 days following their initial/index ED encounter.

  4. Number of 30-day cardiovascular hospital re-admissions

    Time frame: day 30

    30-day cardiovascular hospital re-admissions will be defined as any cardiovascular related hospital admission occurring during the 30 days following their index hospitalization.

  5. Number of Adverse Events

    Time frame: day 30 and Month 12

    Determine if telehealth implementation will result in improved sorting of cases for escalated and de-escalated care, reducing the number of adverse events.

  6. Change in Cost - societal level

    Time frame: day 30 and Month 12

    Evaluate whether spending on healthcare (i.e., insurance payments) changes during the 30-day follow-up period.

  7. Change in Cost - provider level

    Time frame: day 30 and Month 12

    Estimates will be obtained for the impact of the establishment of the telehealth program on the budget of the tertiary center.

  8. Cost-effectiveness

    Time frame: Month 12 and Month 48

    Cost-effectiveness: will be evaluated at the societal level to inform the relative changes in patient outcomes and costs resulting from the telehealth program.

  9. Cardiovascular telehealth consultation rate

    Time frame: Baseline

    Cardiovascular telehealth consultation rate will be assessed by identifying the total number of patients that received cardiovascular telehealth consultations at each originating site divided by the total number of patients at each originating site with cardiovascular symptoms.

  10. Cardiovascular telehealth adoption rate

    Time frame: Month 12

    Adoption rate will be defined by the cardiovascular telehealth consultation rate at each originating site during the first 12 months following implementation of the cardiovascular telehealth service.

  11. Cardiovascular telehealth sustainability rate

    Time frame: Month 24 - Month 48 post Intervention

    Sustainability rate will be defined by the cardiovascular telehealth consultation rate at each site greater than 12 months after the availability of the cardiovascular telehealth service.

Other outcomes

  1. (ED) Emergency Department length of stay (LOS)

    Time frame: Baseline

    ED LOS will be defined as the time from the patient's ED arrival to ED discharge, transfer, or admission

  2. Time to transfer

    Time frame: Baseline

    Time to transfer will be defined by the time between a physician order for transfer and the patient leaving the ED

  3. Patient satisfaction Score

    Time frame: Day 30 and year 1

    Patient satisfaction will be measured (telephone follow-ups) using a modified Short Assessment of Patient Satisfaction (SAPS) which is a validated 7 question instrument, which uses a 5-point Likert scale - scoring: 0 to 10 = Very dissatisfied; 11 to 18 = Dissatisfied; 19 to 26 = Satisfied; 27 to 28 = Very satisfied

Sponsors and collaborators

Lead sponsor

Wake Forest University Health Sciences

Other

Collaborators

  • Health Resources and Services Administration (HRSA)

Registry information

Official study title

Enhancing Rural Health Via Cardiovascular Telehealth for Rural Patients (E-VICTORS) Project

Acronym: E-VICTORS

Important dates

Study start
2021
Primary completion
2025
Study completion
2026
First posted
Nov 5, 2020
Registry last updated
Jul 30, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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