Systems of Care to Promote Care Coordination Meaningful evidence has facilitated a much better under- standing of the systems changes necessary to achieve safer This includes the adoption by all US hospitals of a standardized set of Safe Practices endorsed by the National which overlap in many ways with the National Patient Safety Goals espoused by The Joint Com- Examples of patient safety standards that should be ensured for all patients discharged after STEMI include Table 14. Plan of Care for Patients With STEMI Plan of Care Resources/References Medications Antithrombotic therapies Beta blockers ACE inhibitors/ARBs/aldosterone antagonists Statins ESC STEMI Guideline48 Physical activity/cardiac rehabilitation Physical activity Cardiorespiratory fitness (MET capacity) AHA/ACC 2011 Update: Secondary Prevention and Risk Reduction Therapy249 AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation616 Risk factor modification/lifestyle interventions Smoking cessation AHA/ACC 2011 Update: Secondary Prevention and Risk Reduction Therapy249 ACCP Tobacco Cessation Toolkit615 Diet/nutrition AHA/ACC 2011 Update: Secondary Prevention and Risk Reduction Therapy249 Management of comorbidities Overweight/obesity Lipids Hypertension Diabetes HF Arrhythmia/arrhythmia risk AHA/ACC 2011 Update: Secondary Prevention and Risk Reduction Therapy249 AHA/ACC 2011 Update: Secondary Prevention and Risk Reduction Therapy249 NHLBI National Hypertension Education Program (JNC VII)617 AHA/ADA CVD Prevention in DM Patients618 ACC/AHA/HFSA HF Guideline619 ACC/AHA/HRS DBT & AF Guidelines496,501 Psychosocial factors Sexual activity Gender-specific issues Depression, stress, and anxiety Alcohol use Culturally sensitive issues AHA Scientific Statement on Sexual Activity and Cardiovascular Disease627a Cardiovascular Disease Prevention in Women Guidelines620 AHA Scientific Statement on Depression621 AHA/ACC 2011 Update: Secondary Prevention and Risk Reduction Therapy249 Provider follow-up Cardiologist Primary care provider Advanced practice nurse/physician assistant Other relevant medical specialists Electronic personal health records Influenza vaccination Centers for Disease Control Adult Vaccinations622 Patient/family education Plan of care for acute MI Recognizing symptoms of MI Activating EMS, signs and symptoms for urgent vs emergency evaluations CPR training for family members Risk assessment & prognosis Advanced directives Social networks/social isolation AHA CPR Guideline201 Socioeconomic factors Access to health insurance coverage Access to healthcare providers Disability Social services Community services http://www.qualityforum.org/Topics/Care_Coordination.Aspx AACVPR indicates American Association of Cardiovascular and Pulmonary Rehabilitation; ACC, American College of Cardiology; ACCF, American College of Cardiology Foundation; ACCP, American College of Chest Physicians; ACE, angiotensin-converting enzyme; ADA, American Diabetes Association; AF, atrial fibrillation; AHA, American Heart Association; ARB, angiotensin receptor blocker; CPR, cardiopulmonary resuscitation; CVD, cardiovascular disease; DBT, device-based therapy; DM, diabetes mellitus; EMS, emergency medical services; ESC, European Society of Cardiology; H2H, hospital-to-home; HF, heart failure; HFSA, Heart Failure Society of America; HRS, Heart Rhythm Society; JNC, Joint National Committee; MET, metabolic equivalent; MI, myocardial infarction; NHLBI, National Heart, Lung, and Blood Institute; SIHD, stable ischemic heart disease; and STEMI, ST-elevation myocardial infarction. 