(P242) SECONDARY PREVENTION IN STEMI PATIENTS: INSIGHTS FROM A REGIONAL VIRTUAL STEMI CLINIC (SPARC STUDY)

Background: ST-Elevation Myocardial Infarction (STEMI) patients are often managed in a “Hub and Spoke” model with early repatriation from the Percutaneous Coronary Intervention (PCI)-capable centres to their referring hospital. This fragmented care, along with trends towards earlier discharge post-STEMI, results in suboptimal management of these high-risk patients post-discharge. We implemented an Interventional Cardiology Fellow-led regional Virtual STEMI Clinic (VSC) to identify and manage gaps in care during this critical post-discharge period.

METHODS AND RESULTS: This retrospective chart review included all patients contacted in the VSC from its initiation in November 2023 until April 2024. Patient data was obtained from standardized templates embedded into the electronic medical records (EPIC) and linked to data from the Provincial CorHealth STEMI registry. The datasets included patient demographics, lifestyle and social factors, STEMI-specific procedural details, baseline comorbidities, and medication records. The objectives of the VSC include: (1) identify and engage with post-STEMI patients at 4-6 weeks post-STEMI, (2) identify gaps in guideline-recommended care in STEMI patients post-discharge, (3) optimize medical guideline-recommended medications and facilitate lifestyle modification, (4) ensure appropriate clinical follow-up (cardiac rehabilitation and specialist care). (REB-17413).

The clinic contacted 264 patients within a mean of 5.3±1.7 weeks from their STEMI date, accounting for 71.5% of all STEMI patients (n=369) treated in our centre during that time. Notably, 65 patients (24.6%) had no recent assessment of either their lipids or diabetes status. Of those with a recent lipid profile (n=206), 52 (25.2%) patients had suboptimal lipid control. For those with available HbA1c (n=252), 38 out 51 (74.5%) diabetic patients had inadequate glucose control, and 21 (8.3%) were newly identified as pre-diabetic. Additionally, 32 patients (12.1%) were active smokers, and 73 (27.7%) lacked arrangements for cardiac rehabilitation or specialist follow-up. During the clinic visit, 179 patients (67.8%) had at least one intervention implemented, including 93 (35.2%) with at least one guideline-directed medication adjustment, 84 (31.8%) with further risk-factor evaluation, all active smokers received counselling and resources for smoking cessation, and arrangements were made for all patients lacking cardiac rehabilitation or specialist follow up.

Conclusion: Using a standardized approach, the regional VSC obtained 5-week follow-ups in the majority STEMI patients, identified gaps in evidence-based care and helped optimize guideline-directed medical therapy, lifestyle modifications, and appropriate follow-up. This simple, low-cost VSC model provides a care continuum and holds promise for enhancing post-STEMI care at the provincial and national levels.