Survivors of myocardial infarctions are at increased risk of recurrent infarctions and have an annual death rate of 5%, six times that in people of the same age who do not have coronary heart disease. Despite the existence of published interventions and clinical recommendations aimed at secondary and tertiary prevention their application and adherence statistics in post-myocardial infarction patients are woeful.
The objective of this paper is to detail the creation of a template curriculum that gives best practice recommendations to post STEMI patients in an effort to reduce recidivism by combining current medical methodology with lessons learned from other fields currently addressing the problem of recidivism and relapse.
STEMI 365 is a yearlong program that aims to reduce cardiac recidivism in STEMI survivors. STEMI 365 is composed of three parts: best practice guidelines, evaluation toolkit, and template curriculum. The best practice guidelines document is broken into sections on cardiac rehabilitation, lifestyle modification, drug therapy, patient follow-up and screening, and patient education. All guidelines are informed by the latest recommendations and research in the fields of medicine and relapse prevention. The evaluation toolkit is composed of the cardiac recidivism risk tool, the self-evaluation tool, and the global evaluation tool. The goal of the toolkits is to guide resource allocation by understanding a patient’s unique cardiac recidivism risk, internal sources of potential relapse, and external sources of potential relapse. The Federal Post Conviction Risk Assessment developed by the Administrative Office of the United States Courts informs the toolkits’ construction. The template curriculum is a summation of the programs and interventions that can be utilized by a health system to decrease cardiac recidivism in STEMI survivors. The curriculum addresses one year of time divided into three phases: inpatient, outpatient, and maintenance. The interventions rage in scope from training a patient’s family members in bystander CPR to the creation of a centralized patient monitoring program and post-myocardial infarction clinic. Each phase combines the best modalities in treatment found in the fields of post-myocardial infarction care, hospital re-admission prevention, substance abuse relapse prevention, scholastic dropout prevention, and criminal justice. Personal interviews were conducted with leaders in each field to ensure the correct application of their methodologies.
STEMI 365 provides tools to identify patients at highest risk of cardiovascular relapse, to apply local and regional resources in an effective way based on patient risk, and to customize interventions to a health system’s available resources. STEMI 365 is beginning an application phase at this institution, and will be available to other health systems in the near future.
Patchwork of contrasting medication cultures across the USA