Transition of care to prevent recurrence after acute coronary syndrome: the critical role of the primary care provider and pharmacist

Abstract

Despite therapeutic advances, patients with acute coronary syndrome (ACS) are at an increased longterm risk of recurrent cardiovascular events. This risk continues to rise as the number of associated comorbidities, often observed in patients presenting with ACS, increases. Such a level of clinical complexity can lead to gaps in care and subsequently worse outcomes. Guidelines recommend providing an evidence-based post-discharge plan to prevent readmission and recurrent ACS, including cardiac rehabilitation, medication, patient/caregiver education, and ongoing follow-up. A patientcentric multidisciplinary approach is critical for the effective management of the transition of care from acute care in the hospital setting to the outpatient care setting in patients with ACS. Ongoing communication between in-hospital and outpatient healthcare providers ensures that the transition is smooth. Primary care providers and pharmacists have a pivotal role to play in the effective management of transitions of care in patients with ACS. Guideline recommendations regarding the postdischarge care of patients with ACS and the role of the primary care provider and the pharmacist in the management of transitions of care will be reviewed. ARTICLE HISTORY

Developing a post-myocardial infarction medicines optimisation clinic: core competencies for upskilling pharmacists and initial patient feedback

“…Furthermore, there is growing evidence from other centres in the UK and elsewhere that pharmacist-led models of post-MI medicines optimisation can improve adherence and risk factor control, and that patients appreciate the opportunity such clinics provide for discussing and resolving care-related concerns. [15][16][17][18][19][20] Our model also aligns with guidance on medicines optimisation from the UK's National Institute for Health and Care Excellence, which highlights the importance of structured review, potentially led by a pharmacist when deemed locally appropriate. 21 In addition, the upskilling of advanced clinical pharmacists to conduct these clinics in patients with complex needs fits with the concept of 'advanced pharmacy practice' advocated by leadership bodies such as the Royal Pharmaceutical Society.…”

Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

“…ACS is associated with significant morbidity and death, and older adults are at highest risk. 177 The 30-day readmission rate after ACS ranged from 11% to 14% in a meta-analysis of 14 studies. 178 Death rates vary among populations and range from 7% to 18% in the first year after STEMI.…”

“…On the basis of a Get With The Guidelines approach, Goldman and Harte 177 recommended that the post-ACS discharge plan address 6 elements, including (1) medications, (2) lifestyle modification/cardiac rehabilitation, (3) management of comorbidities, (4) psychosocial support, (5) socioeconomic factors, and (6) patient/family education to include teaching and preparation of patients for their own self-care (Figure 4). Polypharmacy is a frequent issue for older adults and transitions in care should include consideration of deprescribing potentially inappropriate medications and medications that are no longer needed.…”

Nurses’ Role in Discharge Preparation for Acute Coronary Syndrome Patients

“…There is an elevated long term risk of repeated cardiovascular problems in patients with ACS. As the number of related comorbidities, frequently seen in patients presenting with ACS, rises, this risk continue to increase [2]. The risk of recurrence, especially in the first year [3], is still high.…”

“…The disease, patients and health care provider centered problems can lead to these care gaps and contribute to the significant residual risk seen in ACS patients. For instance, if patients are discharge without the awareness of their illness and or their drug regimen, they may neglect to fill in their medication [2]. Patients with post hospitalized heart attack often feel insufficiently ready for the hospital to home transition [6].…”