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CLINICAL STATEMENTS AND GUIDELINES April 1, 2025 Circulation. 2025;151:e771–e862. DOI: 10.1161/CIR.0000000000001309 e824 health behavior and long-term health-related outcomes. Clinicians are well positioned to engage in meaningful dialogue with patients who have experienced an ACS event about secondary prevention and building self-care skills to manage their condition (Table 20). Recovery represents a teachable moment to provide structured education, including priming the patient to attend cardiac rehabilitation (CR). Systematic reviews of educational interventions targeting secondary prevention in patients with coronary heart disease, many of whom have ACS, have demonstrated effectiveness in improving disease-related knowledge, healthy behaviors (eg, smoking cessation, physical activity, healthy dietary behavior), and medication adherence.1–3 The magnitude of the effect on each of these outcomes varies by study. Beyond improved knowledge and behavior change, the impact of individualized education for patients with ACS on morbidity and mortality is less clear. A shortcoming of published educational intervention studies to date is that the interventions are markedly heterogeneous but vary in intensity, duration, delivery mode, resources needed, and outcomes measured. Currently, insufficient comparative data are available to guide clinicians about which specific educational interventions are best. However, evidence supports the use of individualized goal setting that demonstrates respect for the patient and their circumstances, structured content that is culturally appropriate, and clearly defined outcomes.4 Table 20 lists the components that should be discussed with ACS patients at the time of hospital discharge. 10.5.2 Postdischarge Follow-Up and Systems of Care Coordination Synopsis Transition from the hospital to home is a critical period for patients with ACS because approximately 1 in 5 patients are readmitted within 30 days of discharge.1–6 Women, individuals from traditionally underrepresented racial and ethnic groups, and patients who require ICU services during their index hospitalization are particularly at risk for readmission.3 Quality improvement programs such as the Hospital to Home Initiative7 or the AMI Toolkit8 provide resources to assist clinicians decrease readmission rates and improve medication and CR adherence through increased provider communication and care coordination. Transitional care interventions that leverage different types of support (eg, hospital-initiated support, patient and family education delivered before and after discharge, or community-based or chronic disease management models of care) are examples of ways to reduce risk of readmission.9 Hospital-initiated support interventions are associated with reduced mortality rates at 3 months and 1 year as well as a reduction in 30-day readmission rates among patients with AMI.9,10 Multicomponent integrated care (≥2 quality improvement strategies targeting different domains of the health care system, health care professionals, or patients) as compared with usual care has been associated with reduction of all-cause death, cardiovascular mortality, and all-cause hospitalization.11 Emerging digital health interventions hold promise to improve the transition from hospital to home. For additional recommendations on nutrition, physical activity, smoking cessation, and alcohol and substance use, refer to the “2023 AHA/ACC/ACCP/ ASPC/NLA/PCNA Guideline for Management of Patients With Chronic Coronary Disease.”12 Table 21 summarizes the recommended guidance for hospital discharge. 10.5.3 Cardiac Rehabilitation Recommendations for CR Referenced studies that support recommendations are summarized in the Evidence Table. COR LOE Recommendations 1 A 1 Patients with ACS should be referred to an outpatient CR program prior to hospital discharge to reduce death, MI, hospital readmissions, and improve functional status and QOL.1–4 2a B-R 2 In patients with ACS, a home-based CR program is a reasonable alternative to a center-based CR program to improve functional status and QOL.5–9 Synopsis CR is a multifaceted and comprehensive outpatient intervention that is considered the standard of care for secondary prevention of CVD. The primary goals of CR are modifying CVD risk factors and improving patient functional capacity and QOL with the goal of reducing subsequent morbidity and mortality. Through a combination of monitored exercise training, health and nutrition education, psychological support, and personalized patient assessment, including medication optimization (Figure 10), CR has been shown to lower the risk of cardiovascular and all-cause death, reduce hospital readmissions, and to be cost-effective.10,11 Despite its proven benefits, CR is underutilized and referral rates to CR are low, especially for wom- Table 20. Essential Components of Patient Education Reason for hospitalization (explain reason for admission, diagnostic tests, procedural results) Tailored discussion of lifestyle modifications (AHA’s Life’s Essential 8)5 Medications (written and verbal instructions including purpose, dose, frequency, potential adverse effects of each medication; refill instructions; changes to prehospital regimen; importance of adherence) Symptom management (what to monitor for and actions to take should symptoms recur, including whom to call) Returning to daily routine (when to resume physical activity, sexual activity, work, and travel) Psychosocial considerations (open dialogue about symptoms of depression and anxiety) Follow-up care (future appointments with cardiology, CR, additional testing postdischarge) AHA indicates American Heart Association; and CR, cardiac rehabilitation. Downloaded from http://ahajournals.org by on October 7, 2026