February 2026

Long-term care of patients of an ST-elevation myocardial infarction (STEMI) relies on pharmacotherapy and risk modification.

Each February, American Heart Month reminds us that cardiovascular disease remains the leading cause of death in the United States. For primary care providers, this is a powerful moment to refocus on the long‑term care of patients who have survived a ST‑elevation myocardial infarction (STEMI). While the acute event is managed in the hospital, the trajectory of a patient’s recovery — and their risk of future events — is shaped in primary care.

STEMI survivors remain at lifelong risk for recurrent MI, arrhythmias, heart failure, and sudden cardiac death. Most of the modifiable drivers of that risk — hypertension, diabetes, dyslipidemia, smoking, obesity, CKD, and physical inactivity — are managed in the outpatient setting. This makes primary care the backbone of secondary prevention.

Why this matters in primary care 

Patients who survive the initial hospitalization and early recovery phase have excellent long‑term survival prospects. However, even after successful PCI, patients face ongoing risk. Most secondary prevention happens outside cardiology. Risk‑factor control, lifestyle change, mental health screening, and medication optimization are all longitudinal processes that require primary care continuity. Patients often leave the hospital on complex regimens. Without reinforcement, adherence drops sharply within the first 90 days — the period with the highest risk of recurrent events. Early and consistent primary care follow‑up reduces avoidable readmissions, improves medication adherence, and identifies complications sooner.

Core Components of Outpatient STEMI Management

After a STEMI, long‑term pharmacotherapy is the foundation of secondary prevention, and primary care plays a central role in ensuring these therapies are initiated, tolerated, and continued. Their effectiveness depends not only on prescribing them, but on ensuring patients understand their purpose, tolerate them well, and remain adherent over time — work that happens almost entirely in primary care.

1. Antiplatelet Therapy

• DAPT (aspirin + P2Y12 inhibitor) for 12 months after PCI unless bleeding risk dictates otherwise.
• After 12 months, most patients remain on lifelong aspirin.

2. High-intensity Statin Therapy

• All STEMI survivors should receive a high‑intensity statin.
• Many cardiology groups now target LDL <55 mg/dL for very high‑risk patients.

3. Beta-Blockers

• Reduce arrhythmias and support ventricular remodeling.
• Continue for at least 3 years, longer if LV dysfunction persists.

4. ACE Inhibitors or ARBs

• Improve survival and reduce remodeling.
• Essential in patients with diabetes, CKD, hypertension, or LV dysfunction.

5. SGLT2 Inhibitors and GLP-1 RAs

Not STEMI‑specific, but increasingly used in post‑MI patients with diabetes, CKD, obesity, or heart failure because they:

• Reduce cardiovascular events
• Improve HF outcomes
• Support weight and glycemic control

Monitoring and Follow‑Up

After discharge, early and consistent follow‑up is essential. Patients should be seen within one to two weeks to review medications, assess symptoms, reinforce adherence, and ensure enrollment in cardiac rehabilitation. This visit is also an opportunity to clarify the discharge plan, address psychosocial stressors, and evaluate blood pressure, heart rate, and any early signs of heart failure. As recovery continues, primary care plays a central role in ongoing surveillance: monitoring lipids, renal function, glucose control, and blood pressure; reassessing lifestyle goals; and adjusting therapy as needed. Because post‑MI depression and anxiety are common and strongly linked to worse outcomes, routine mental health screening should be integrated into these visits.

Long‑term follow‑up focuses on maintaining secondary prevention targets, supporting behavior change, and identifying complications early. This includes watching for evolving heart failure symptoms, ensuring adherence to antiplatelet and cardioprotective medications, and revisiting smoking cessation, nutrition, physical activity, and weight management at each visit. With steady, proactive outpatient care, primary care providers can dramatically reduce the risk of recurrent events and help patients regain stability and confidence after a STEMI.

These interventions, and consistent follow up with dedicated primary care providers, often have a larger impact on long‑term outcomes than any single medication.

The Bottom Line for Primary Care

STEMI survivors need aggressive secondary prevention, close follow‑up, and long‑term risk‑factor management. Primary care providers are central to this work. As American Heart Month reminds us each February, cardiovascular disease prevention is not a one‑time intervention — it’s a lifelong partnership. With optimized outpatient care, patients can not only survive but truly thrive after a STEMI.

February Is Cancer Prevention Month — and Vaccination Remains One of Our Most Powerful Tools

Cancer Prevention Month is a reminder that the most effective cancer prevention interventions often happen long before symptoms or screening. HPV and hepatitis B vaccines prevent the viral infections that drive cervical, oropharyngeal, anal, vulvar, vaginal, penile, and liver cancers.

In 2026, primary care clinicians are navigating updated vaccine schedules and widening gaps in vaccination uptake. Despite this the evidence remains clear: vaccination is upstream cancer prevention, and primary care is the engine that makes it work.

Why These Vaccines Matter

HPV vaccination

• Prevents infection with high-risk HPV types responsible for the majority of cervical and oropharyngeal cancers.
• Works best when given early — ideally at ages 9 through 12.
• Now supported by strong evidence that one dose provides protection comparable to the previous two-dose series.

Hepatitis B vaccination

• Prevents chronic HBV infection, the leading cause of hepatocellular carcinoma worldwide.
• Universal adult vaccination (ages 19–59) and universal one time HBV screening simplify workflows and reduce missed opportunities.
• The two-dose Heplisav B series improves completion rates, especially in populations with inconsistent follow up.

Vaccination is not just infectious disease prevention — it is cancer prevention.

Updated Recommendations for 2026

HPV: One Dose Routine Schedule

• Routine vaccination at age 11–12 is now a single dose.
• Catch up vaccination remains recommended through age 26.
• Adults 27–45 continue to use shared decision making.
• Immunocompromised individuals may still require multi dose schedules.

This simplifies messaging and improves completion — a major win for cancer prevention.

HBV: Universal Adult Vaccination and Flexible Dosing

• Universal HBV vaccination for all adults ages 19–59.
• Adults 60+ vaccinated based on risk or preference.
• Universal one time HBV screening for all adults.
• Flexible vaccine options:
  • Traditional three-dose series
  • Two-dose Heplisav B series completed in one month

These updates streamline workflows and reduce the burden of chronic HBV infection. Primary care clinicians are the stabilizing force and patients will look to you for clarity and guidance.

How This Connects to HEDIS Measures

Several HEDIS* (Healthcare Effectiveness Data and Information Set) measures intersect directly with vaccine preventable cancers:

Optimizing vaccine uptake strengthens both clinical outcomes and quality performance.

What Primary Care Prescribers Can Do Now

1. Normalize early vaccination

• Recommend HPV vaccination at ages 9–12 as routine cancer prevention.
• Use confident, presumptive language (“Today we’ll give the HPV vaccine”).

2. Catch up adolescents and adults

• Offer HPV vaccination through age 26; use shared decision making for adults 27–45.
• Screen all adults once for HBV and vaccinate if non immune.
• Use the 2 dose HBV option when adherence is a concern.

3. Integrate vaccination into every workflow

• Add vaccine status to rooming and chronic care visits.
• Use standing orders to reduce missed opportunities.
• Pair HBV screening with vaccination in the same encounter.
• Build HPV and HBV vaccination into adolescent and adult preventive bundles.

4. Address hesitancy with clarity and empathy

• Keep messaging simple: “This vaccine prevents multiple types of cancer.”
• Validate concerns without reinforcing misinformation.
• Emphasize safety and decades of data.

Bottom Line

Vaccines remain among the most powerful cancer prevention tools in primary care. Even amid evolving recommendations, the evidence is clear: HPV and HBV vaccination prevent cancers that disproportionately affect underserved communities.

Primary care prescribers can stabilize the landscape by offering clear, confident, evidence based guidance — and by embedding vaccination into everyday workflows. A strong recommendation today can change a patient’s cancer risk trajectory for life.

*HEDIS is standardized population health management tool that comprises more than 90 standardized measures that track care delivery. The data are used to determine the effectiveness of care.  

Here's how providers can avoid financial sanctions if they refer Independent Health patients to out-of-network providers. 

Occasionally, a participating provider may refer an Independent Health patient to another provider for a second opinion or for treatment. Please remember it is important to make sure that you refer to a provider who participates with the patient’s specific Independent Health plan as required by the Provider Financial Sanction policy and your participating provider agreements with Independent Health. It is also the provider’s responsibility to obtain preauthorization if referring the patient to an out-of-network provider, as indicated in the Out-of-Network Requests for Authorization policy. 

Independent Health may impose a financial sanction on the referring provider for failing to adhere to our policies, procedures, and contractual requirements. Please refer to Independent Health’s Provider Financial Sanction policy (M20160226008), which indicates:

Independent Health actively monitors and audits participating providers for compliance with established policies, procedures, rules and the participating providers’ agreement with Independent Health.  Failure to adhere to Independent Health’s policies, procedures, and contractual requirements may result in a financial sanction.  The amount of the sanction shall be at Independent Health’s discretion and without regard to whether or not the claim paid, denied, or was retracted.  Unless the possibility of sanction is already articulated in the policy which is the subject of the violation, a financial sanction will not be imposed without a prior notice or warning being given to the provider.

Payment of a financial sanction may be effectuated by any means established by Independent Health in its sole discretion, including but not limited to a request for payment from the provider or an off-set against payment upon 30 days’ advance notice to the provider.

You may use our Find-a-Doc feature on our website to check if a provider is in-network for a particular plan. For your reference, the policies cited here (M20160226008 and M850101075) are posted in the secure provider portal.  

Current neurosurgery and chiropractic networks are adequate for member need; future updates will be noted in the Spotlight section.

Health-related social needs, osteoporosis management

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Remember to view our up-to-date policies online.