SECONDARY PREVENTION IN STEMI PATIENTS: INSIGHTS FROM A REGIONAL VIRTUAL STEMI CLINIC

Background In many Canadian regions, 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 post-discharge period. We implemented a regional Virtual STEMI Clinic (VSC) to identify and address gaps in post-discharge care. Methods We performed standardized virtual follow-ups for STEMI patients who presented at one tertiary hospital (hub) between 11/2023 to 11/2024. 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 (IQR 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, while 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 post-discharge including lifestyle modification, guideline-recommended medication optimization, and appropriate follow-up.