Post acute care of ischemic heart disease patients is suboptimal. The division of cardiology at the Toronto East General Hospital (TEGH) and the Partners For Health (PFH), in cooperation with the division of Family Practice of the East York Access Centre developed and evaluated a community care pathway following a myocardial infarction (MI). Development of this Home Care After a Heart Attack pathway was costly, resource intensive, and required multiple in-kind contributions from health care professionals for successful implementation. Economies of scale will not be achieved unless individual hospitals and home care programs are discouraged from developing community care pathways on their own. Care pathways should be developed and standardized at the national level, and community providers should be adequately compensated for the shift in burden of care from hospital to community.

Background: Post acute care of ischemic heart disease patients is suboptimal. The division of cardiology at the Toronto East General Hospital (TEGH) and the Partners For Health (PFH), in cooperation with the division of Family Practice of the East York Access Centre, conducted a study to determine whether an accepted methodology, in accordance with the American Heart Association's Scientific Statement on Pathways to develop a post myocardial infarction (MI) pathway at the local level. The aim of this integrated community care pathway was to provide recommendations to home care professionals regarding their management of patients discharged from an acute hospitalization to home for up to 2 months following acute care discharge.

Methods: The investigators: (a) convened a cross-sectional team of care providers, (b) defined the purpose of the pathway and established the medical criteria, (c) identified the timeline and the key components, (d) formatted the pathway, (e) educated staff, and (f) implemented the pathway.

The Home Care After a Heart Attack Pathway included: (a) a minimum of 2 visits by home health nurses within one week post discharge, (b) an additional 2 visits in the second week, (c) and a single visit in weeks 3 and 6. The substantive components deemed essential were: (a) physical assessment, (b) risk factor assessment, (c) mobility guidelines, (d) environment & functional assessment, (e) psychosocial management, (f) nutritional assessment, (g) medication compliance, (h) laboratory and diagnostic test follow up reinforcement, and (i) community resources and follow up.

Conclusions: Development of the Home Care After a Heart Attack pathway was costly, resource intensive, and required multiple in-kind contributions from health care professionals for successful implementation. Economies of scale will only be achieved if individual hospitals and home care programs are not encouraged to develop community care pathways on their own. Care pathways should be developed and standardized at the national level, and community providers should be adequately compensated for the shift in burden of care from hospital to community.

Reference: Young W, Rewa G, Coyte PC, Jaglal SB, Goodman S, Bentley-Taylor M, Fountas P, Gupta A, Levinson A, O'Connor T, Partners for Health's Home Care after a Heart Attack Project Group. The development of partners for health's integrated community pathway for post myocardial infarction patients. The Canadian Journal of Cardiology, 2003; 19(3): 231-235.

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