Cardiology Fellow McMaster University Hamilton, Ontario, Canada
Background: Despite improvements in acute care, patients with atherosclerotic cardiovascular disease (ASCVD) remain at risk for recurrent events after hospital discharge. While guideline-based secondary prevention strategies such as pharmacotherapy, lifestyle interventions, and structured follow-up are effective, their implementation is often inconsistent and fragmented, particularly during the transition from hospital to community care. To address this, the Canadian Cardiovascular Society (CCS) has developed a secondary prevention pathway aimed at standardizing care and improving uptake of evidence-based recommendations post-ACS (acute coronary syndrome). The aim of this presentation is to describe the development and implementation process of the secondary prevention pathway, including pathway design, multidisciplinary collaboration, and integration into clinical workflows.
METHODS AND RESULTS: A multidisciplinary working group—including cardiologists, pharmacists, primary care clinicians, knowledge translation researchers, Ontario Health representatives and patient partners—led the development of the CCS secondary prevention pathway. The pathway was informed by national and international (e.g., Canadian Cardiovascular Society [CCS], Canadian Action Plan for Cardiovascular Rehabilitation [CAPCR], American Heart Association/American College of Cardiology [AHA/ACC], European Society of Cardiology [ESC]) to ensure it was grounded in current evidence and best practices. The resulting pathway outlines five core objectives: (1) Establishing follow-up plans, (2) Completing necessary investigations, (3) Implementing guideline-directed medical therapy, (4) Providing education and resources to patients and caregivers, and (5) Ensuring clear communication and documentation across care transitions. Pilot implementation of the pathway was undertaken at two cardiac centres and their referral regions in Ontario. To inform the pathway's development and future implementation, purposeful sampling of both hospital-based and community healthcare providers was employed to assess current secondary prevention practices, identify clinical-practice gaps, and highlight priority areas that require attention. Feedback from these surveys and from stakeholder consultation will be used to refine the pathway, to enhance feasibility, acceptability, and alignment with local practice patterns.
Conclusion: This evidence-based, multidisciplinary pathway aims to standardize secondary prevention for post-ACS patients post-discharge, with a focus on comprehensive care delivery and improved transitions. A multidisciplinary team of stakeholders, involved in all stages of pathway development, is ensuring both a clinically and locally relevant tool to enhance adherence to guideline-directed care and optimize patient outcomes across Canada.
