Transitions of Care Pharmacist Impact Following Hospitalization for Acute Myocardial Infarction summary

In this PACUPod episode, the study by Augustine et al. on pharmacist-led transitions of care (TOC) after hospitalization for acute myocardial infarction (AMI) is examined. The real-world, single-center pre-post design compares outcomes before and after implementing a TOC service focused on medication reconciliation, patient education, and discharge optimization. The primary outcome was 90-day cardiovascular readmissions; secondary outcomes included 30-day cardiovascular and all-cause readmissions and discharge on defect-free guideline-directed medical therapy (GDMT). Results showed no significant reduction in 90-day cardiovascular readmissions (10.7% pre-TOC vs 9.9% post-TOC; OR 0.937, p=0.842). However, discharge on defect-free GDMT improved markedly from 61.5% to 87.7% (OR 5.424, p<0.001), highlighting a substantial process improvement even when short-term clinical outcomes did not change. Limitations include lack of randomization, use of historical controls, and absence of confounding adjustments, which limit generalizability. The episode discusses the implications of improved GDMT adherence, the essential role of medication reconciliation and patient education in TOC, and the need for outpatient follow-up and adherence monitoring to translate process gains into long-term clinical benefits. Looking ahead, the evidence suggests the value of larger multicenter randomized trials that incorporate outpatient adherence and patient-reported outcomes to better define the impact on readmissions and cardiovascular health.