Improving Communication With GPs Post-STEMI

JJ Coughlan; Conor Hickie; Barbara Gorna; Ross Murphy; Peter Crean


Br J Cardiol. 2016;23(4):138-140. 

In This Article


Numerous trials have demonstrated the benefit of secondary prevention post-STEMI.[3–9] This consists of medical treatment with DAPT, a statin and a BB. In patients with evidence of left ventricular dysfunction, ACEi have also been shown to confer a prognostic benefit.[12] Adequate secondary prevention reduces major adverse cardiac events.[10.]

With improvements in management, inpatient stays for patients with acute infarcts have shortened considerably.[13] This may make it difficult to up-titrate medication regimens to therapeutic dosages while under the care of the specialist team. In addition, some medications require monitoring of haemodynamic parameters like heart rate and blood pressure, or biochemical parameters like electrolytes and renal function, before deciding on dose up-titration. As such, the GP plays a crucial role in performing this as an outpatient. In order to facilitate this, it is essential that specialist care providers explicitly detail the need for up-titration of medications with instructions for the same.

The need to optimise outcomes post-MI is well described. Coronary artery disease is the leading cause of death in Ireland[1] and amounts to a significant cost burden on the healthcare system. A study from the UK estimated the financial burden of suboptimal care post-MI to be in the region of £9 billion.[14]

Discharge summaries are a crucial component of the patient care pathway. They represent the continuation of care between specialist services and primary healthcare practitioners. They are an opportunity to communicate future plans for ongoing patient management and to provide guidance on long-term care with regard to medication regimens. However, these are usually completed by junior staff, who may be unaware of the guidelines regarding communication with primary care. They may also be uncomfortable explicitly dictating plans for up-titration of medications unless they themselves are explicitly informed of the same by their senior colleagues.

Our junior doctors rotate at three-monthly intervals through our service. Such frequent turnover presents a further challenge. In order to tackle this, an educational session was delivered to the incoming doctors regarding the results of our previous study and NICE guidelines on communication with GPs post-STEMI. As seen in Table 2, this resulted in statistically significant improvements in rates of compliance with guidelines on communication with regard to medication up-titration and duration of DAPT.

This highlights the importance of continuous education of junior staff with regard to guidelines for communication. Improving this communication may, in turn, improve our patients' long-term outcomes, by ensuring they are on the optimum secondary prevention regimen post-STEMI.