Abstract

Background Rural and remote patients presenting with acute coronary syndrome (ACS) experience delays in diagnosis and reperfusion, contributing to higher mortality than those presenting to tertiary centres. Evidence supporting system-triggered diagnostic interventions across the full spectrum of ACS remains limited. Methods In a multicentre, cluster-randomised controlled trial, 29 rural emergency departments in New South Wales, Australia, were assigned to either a system-triggered diagnostic telemedical support from a tertiary centre (MORACS intervention) or usual care. Adult patients presenting with symptoms consistent with ACS were included in the study. The primary outcome was all-cause death. Secondary outcomes included 30-day and 1-year death, length of hospital stay and 30-day readmission rate. Results Between December 2018 and April 2020, ACS was confirmed in 587 of 7474 emergency department presentations consistent with possible ACS. Of these, 274 (47%) presented to MORACS intervention hospitals and 313 (53%) presented to control hospitals. Over a median follow-up of 62 months, all-cause death occurred in 54 patients (20%) in the intervention group and 85 patients (27%) in the control group, representing a 30% lower risk of death with the MORACS intervention (HR 0.70; 95% CI, 0.49?0.98; P = 0.036). The mortality benefit was consistent across both the ST-elevation ACS (STEACS) and non-ST elevation ACS (NSTEACS) subgroups. No significant differences were observed in length of stay or 30-day readmissions. Conclusions The MORACS intervention significantly reduced all-cause mortality among …

Date

2025

Authors

Matthew French, Georgia Meagher, Christopher Ray Chen, Fiona Dee, Lindsay Savage, James Leitch, Conrad Loten, Olivia Watson, Kerry Inder, Dawn McIvor, Trent Williams, Peter Fletcher, John K French, Ammar Albayati, Shanathan Sritharan, Daniel Barker, Ashleigh Stuart, Mohammed Sami Al-Omary, Allan Davies, John Attia, John Wiggers, Aaron L Sverdlov, Nicholas Collins, Andrew J Boyle

Journal

medRxiv

Pages

2025.11. 26.25341123

Publisher

Cold Spring Harbor Laboratory Press