Heart@Home: Safe, at-home care for people with acute heart problems compared with hospital care

Inclusion Criteria:

* Age ≥18 years.
* Residence in the Tel Aviv area, allowing accessibility of the treating team and a rapid response when required.
* Mental capacity to provide informed consent and the ability to understand and follow medical recommendations.
* Availability of a family member or caregiver who agrees to remain with the patient during the first 24 hours of Hospital-at-Home care and to be available for periodic assessments as needed. This requirement may be waived at the discretion of the patient and treating physician for highly independent patients.
* Suitable home environment with Wi-Fi connectivity to support remote monitoring.
* Adequate technological literacy of the patient or caregiver to use the required technology.
* Clinically stable and at low risk of rapid deterioration, based on vital signs and initial assessments as determined by the treating physician.
* The primary indication for hospitalization is one of the following: acute myocardial infarction, pulmonary embolism, pericarditis/myocarditis, heart failure, following transcatheter valve replacement or repair, following pacemaker or implantable cardioverter-defibrillator implantation,.

Disease-Specific Inclusion Criteria

In addition to the general inclusion criteria, patients must meet the relevant disease-specific criteria:

1. Acute Myocardial Infarction

   Acute myocardial infarction with or without ST-segment elevation (STEMI or NSTEMI), treated with primary percutaneous coronary intervention (PCI). The intervention must have been performed in a coronary artery other than the proximal left anterior descending (LAD) artery or left main coronary artery, with TIMI grade III flow at the end of the procedure, no additional critical coronary artery stenoses, an uncomplicated PCI without periprocedural complications, and preserved left ventricular systolic function (LVEF \>45%).
2. Pericarditis/Myocarditis

   Initial diagnosis of pericarditis or myocarditis, with no more than a mild pericardial effusion and preserved left ventricular systolic function (LVEF ≥50%).
3. Pulmonary Embolism

   Low-intermediate-risk pulmonary embolism following echocardiographic and CT angiographic (CTA) assessment and treatment with oral or subcutaneous anticoagulation; or intermediate-high-risk pulmonary embolism following successful mechanical thrombectomy, with subsequent improvement in hemodynamic and echocardiographic parameters.
4. Following Transcatheter Valve Replacement or Repair

   Patients following uncomplicated transcatheter aortic valve replacement (TAVR), or transcatheter edge-to-edge repair (TEER) of the mitral or tricuspid valve, with no clear indication for pacemaker implantation.
5. Heart Failure

   Newly diagnosed (de novo) heart failure or worsening of pre-existing heart failure, regardless of left ventricular ejection fraction (LVEF), with symptomatic NYHA functional class II-IV heart failure requiring hospitalization.
6. Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation.

Exclusion Criteria:

* Pregnancy.
* Inability to provide informed consent.
* Clinically unstable medical condition or significant risk of developing hemodynamic or cardiovascular instability.
* Requirement for continuous intravenous infusion of fluids or medications.
* Uncontrolled pain.
* Active significant non-cardiovascular comorbid condition, including acute ischemic stroke, active bleeding, severe exacerbation of pulmonary disease, or sepsis.
* Hemoglobin \<8 g/dL.
* Estimated glomerular filtration rate (eGFR) \<20 mL/min/1.73 m².
* History of non-adherence to medical treatment or failure to attend follow-up visits.
* Residence in a facility that provides on-site medical care, such as a nursing facility.
* Significant cognitive impairment interfering with the patient's ability to adhere to treatment or participate in education and self-care.
* Inability to obtain peripheral intravenous access, including vascular access requiring ultrasound guidance.