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Secondary Prevention in STEMI Patients: Insights from a Regional Virtual STEMI Clinic
Mina Garas1,2, Paul Mundra1, Brian McGrath1
1McMaster University, Department of Medicine, Hamilton, Ontario, Canada.
Insights
A virtual STEMI clinic improved secondary prevention for heart attack patients post-discharge. This program identified and addressed critical gaps in care, optimizing treatment and follow-up for better patient outcomes.
Area of Science:
- Cardiology
- Public Health
- Digital Health
Background:
- Canadian ST-elevation myocardial infarction (STEMI) care often uses a hub-and-spoke model with early repatriation and rapid discharge.
- This model may lead to suboptimal secondary prevention in the crucial post-discharge period.
- A regional virtual STEMI clinic (VSC) was implemented to address these care gaps.
Purpose of the Study:
- To implement and evaluate a regional virtual STEMI clinic (VSC).
- To identify and address gaps in secondary prevention for STEMI patients post-discharge.
- To analyze factors associated with the need for secondary prevention interventions.
Main Methods:
- Standardized virtual follow-ups were conducted for STEMI patients at a tertiary hospital hub.
- Data on patient characteristics and secondary prevention interventions were collected.
- Poisson regression analysis identified factors associated with requiring interventions.
Main Results:
- The VSC followed 586 STEMI patients (74.6% of total) within a median of 3.9 weeks post-discharge.
- Significant issues identified included inadequate glucose control in 62.2% of diabetics and suboptimal lipid status in 19.9% of patients.
- 73.1% of patients received interventions, including medication adjustments, bloodwork, and cardiac rehabilitation referrals.
Conclusions:
- A structured VSC facilitates timely post-STEMI follow-up.
- The VSC effectively identified and addressed critical secondary prevention gaps.
- Interventions included lifestyle modification support, medication optimization, and appropriate follow-up care.
Background:
In many Canadian regions, ST-elevation myocardial infarction (STEMI) patients are managed in a "hub and spoke" model with early repatriation to referring hospitals and rapid discharge pathways that may lead to suboptimal secondary prevention during the critical postdischarge period. We implemented a regional virtual STEMI clinic (VSC) to identify and address gaps in postdischarge care.
Methods:
We performed standardized virtual follow-ups for STEMI patients who presented at one tertiary hospital (hub) between November 2023 and November 2024. Standardized VSC follow-up data were used to describe baseline characteristics and secondary prevention interventions. Poisson regression was used to identify baseline characteristics associated with the likelihood of requiring secondary prevention interventions to achieve guideline-directed post-STEMI care.
Results:
A total of 586 patients were seen in the VSC within a median of 3.9 weeks (interquartile range 2.6) post-STEMI, representing 74.6% of all STEMI patients treated at our centre. Notably, 62.2% of diabetic patients had inadequate glucose control, 19.9% of all patients had a suboptimal lipid status, and 6.6% were newly identified as prediabetic. A total of 73.1% of patients received at least one intervention, including guideline-recommended medication adjustment (35.7%), bloodwork recommendation (31.0%), and referral to cardiac rehabilitation (30.6%). Diabetes was associated with an increase in the rate of new interventions, and every 10-year increase in age was associated with a decrease. The discharging hospital was not a significant predictor of new interventions.
Conclusions:
A structured VSC enabled timely post-STEMI follow-up, identifying and addressing key gaps in secondary prevention postdischarge, including lifestyle modification, guideline-recommended medication optimization, and appropriate follow-up care.
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