Strengthening Transitions in Care for Patients with ST-Elevation Myocardial Infarction: A Theory-Based Qualitative Study

<h2>Abstract</h2><h3>Background</h3> Despite strong evidence for secondary prevention after ST-elevation myocardial infarction (STEMI), adherence to pharmacotherapy and participation in cardiac rehabilitation remain suboptimal. Fragmented transitions from hospital to outpatient care contribute to early discontinuation, inadequate self-management support, and delayed functional and psychological recovery, particularly in regional systems without standardized follow-up care. This study examined barriers and enablers to post-STEMI transitions in care using a theory-informed qualitative approach. <h3>Methods</h3> Semi-structured interviews were conducted with STEMI patients (n = 14), healthcare providers (n = 8), and system leaders (n = 4) within a regional cardiac network in Ontario, Canada. Interview guides were informed by the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using directed content analysis. <h3>Results</h3> Patients reported barriers including knowledge gaps about symptoms and treatment (TDF domain: knowledge), difficulty sustaining behavioural routines (TDF: behavioural regulation domain), and logistical challenges in accessing services (TDF: environmental context and resources domain). Providers and leaders emphasized poor communication across settings (CFIR: networks and communication construct), limited follow-up planning (CFIR: planning construct), and lack of sustainable funding models (CFIR: available resources construct). Enablers included strong social support (TDF: social influences domain), expanded roles for nurse practitioners and pharmacists (TDF: social/professional role and identity domain), and openness to virtual follow-up models (CFIR: adaptability construct). Suggested solutions include structured discharge education, interdisciplinary collaboration, standardized follow-up systems, and fostering a culture supportive of implementation. <h3>Conclusions</h3> Applying behavioural and implementation frameworks identified multilevel barriers and enablers to post-STEMI follow-up. Actionable strategies, such as structured education, interdisciplinary care, and expanded nonphysician roles, could strengthen secondary prevention and improve outcomes.