Strengthening Transitions in Care for Patients with ST-Elevation Myocardial Infarction: A Theory-Based Qualitative
Jacob Crawshaw1,2,3, Marija Corovic1,2, Muhammad Ajlan2
1Centre for Evidence-Based Implementation, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Insights
Improving care transitions after ST-elevation myocardial infarction (STEMI) requires addressing patient knowledge gaps and logistical barriers. Enhanced communication and structured follow-up systems are key to strengthening secondary prevention and improving patient outcomes.
Area of Science:
- Cardiology
- Health Services Research
- Implementation Science
Background:
- Secondary prevention adherence post-ST-elevation myocardial infarction (STEMI) is suboptimal.
- Fragmented care transitions hinder recovery and self-management.
- Regional systems often lack standardized post-STEMI follow-up care.
Purpose of the Study:
- To examine barriers and enablers to post-STEMI care transitions.
- To identify strategies for improving adherence to secondary prevention.
- To inform the development of standardized follow-up systems.
Main Methods:
- Qualitative study using semi-structured interviews with STEMI patients, healthcare providers, and system leaders.
- Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) informed interview guides.
- Directed content analysis of interview data.
Main Results:
- Patient barriers included knowledge gaps, difficulty maintaining routines, and logistical challenges.
- Provider/leader barriers involved poor inter-setting communication, limited planning, and funding issues.
- Enablers included social support, expanded roles for advanced practitioners, and virtual care openness.
Conclusions:
- Multilevel barriers and enablers to post-STEMI follow-up were identified using behavioral and implementation frameworks.
- Structured education, interdisciplinary collaboration, and expanded non-physician roles can improve secondary prevention.
- Targeted strategies are essential for strengthening post-STEMI care transitions and patient outcomes.
Background:
Despite strong evidence for secondary prevention after ST-elevation myocardial infarction (STEMI), adherence to pharmacotherapy and participation in cardiac rehabilitation remain suboptimal. Fragmented transitions from hospital to outpatient care contribute to early discontinuation, inadequate self-management support, and delayed functional and psychological recovery, particularly in regional systems without standardized follow-up care. This study examined barriers and enablers to post-STEMI transitions in care using a theory-informed qualitative approach.
Methods:
Semi-structured interviews were conducted with STEMI patients (n = 14), healthcare providers (n = 8), and system leaders (n = 4) within a regional cardiac network in Ontario, Canada. Interview guides were informed by the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using directed content analysis.
Results:
Patients reported barriers including knowledge gaps about symptoms and treatment (TDF domain: knowledge), difficulty sustaining behavioural routines (TDF: behavioural regulation domain), and logistical challenges in accessing services (TDF: environmental context and resources domain). Providers and leaders emphasized poor communication across settings (CFIR: networks and communication construct), limited follow-up planning (CFIR: planning construct), and lack of sustainable funding models (CFIR: available resources construct). Enablers included strong social support (TDF: social influences domain), expanded roles for nurse practitioners and pharmacists (TDF: social/professional role and identity domain), and openness to virtual follow-up models (CFIR: adaptability construct). Suggested solutions include structured discharge education, interdisciplinary collaboration, standardized follow-up systems, and fostering a culture supportive of implementation.
Conclusions:
Applying behavioural and implementation frameworks identified multilevel barriers and enablers to post-STEMI follow-up. Actionable strategies, such as structured education, interdisciplinary care, and expanded nonphysician roles, could strengthen secondary prevention and improve outcomes.
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