Optimising post-acute coronary syndrome care: the case for a structured 14-day check

We read with interest the review by Rai et al on managing post-acute coronary syndrome (ACS) patients in primary care. ¹ The authors correctly highlighted the critical failure in the current system as evidenced by the high 30-day readmission rate for post-ACS patients. This is correctly attributable to the ‘disjointed’ transition from hospital to primary care and the ‘underutilisation’ of key interventions such as cardiac rehabilitation.

We suggest a formal, structured, and incentivised primary care review for all post-ACS patients within 14 days of discharge. It is well known that this immediate post-discharge period carries the highest risk of complications, non-adherence, and preventable readmission.

This ‘post-ACS check’, which is analogous to the 6-week postnatal check, can therefore be the first real-world opportunity to (a) screen for aforementioned red flags and confirm adherence to secondary prevention medications; and (b) address the well-known psychological concerns related to a significant cardiac event and promote health literacy, including a targeted lipid intervention, side-effect discussions, and support for engagement with cardiac rehabilitation programmes.

This is not about creating added work but about smarter, more proactive care. A single structured review (perhaps added to the Quality and Outcomes Framework) would prevent the multiple reactive appointments, A&E attendances, and preventable readmissions that our current passive system guarantees.