From the Guidelines
Appropriate care after a myocardial infarction (MI) includes cardiac rehabilitation and medication management.
Key Components of Care
- Cardiac rehabilitation: This includes exercise training, education, counseling, and behavioral interventions to improve prognosis by modifying lifestyle habits and increasing treatment adherence 1.
- Medication management: Therapy with aspirin, a beta blocker, and an ACE inhibitor may be beneficial, particularly for patients with low ejection fractions or anterior infarctions 1.
Benefits of Cardiac Rehabilitation
- Improves exercise tolerance and reduces cardiovascular complications 1
- Decreases anginal pain and improves symptoms of heart failure 1
- Improves blood lipid levels and reduces cigarette smoking 1
- Decreases stress and improves psychosocial well-being 1
Importance of Referral to Cardiac Rehabilitation
- Physician referral is the most powerful predictor of patient participation in a cardiac rehabilitation program 1
- Women and the elderly are referred less frequently to cardiac rehabilitation programs, despite deriving benefit from them 1
Long-term Management
- Evaluation of LV function should be performed before hospital discharge 1
- Standard postinfarction medical therapy should be prescribed as defined in the ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction 1
- Pharmacological stress or dynamic exercise should be used for risk stratification to determine who would benefit from coronary revascularization 1
From the Research
Appropriate Care after Myocardial Infarction (MI)
The care after a myocardial infarction (MI) involves a combination of medical treatments, lifestyle modifications, and rehabilitation. The following are key aspects of appropriate care after MI:
- Complete revascularization followed by unrestricted access to rehabilitation, electrotherapy, and cardiac care 2
- Medication adherence for secondary prevention, including dual antiplatelet therapy (DAPT), lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and beta-blockers (BB) 3
- Intensive treatment of modifiable coronary artery risk factors, including hypertension, hyperlipidemia, and diabetes 4
- Risk stratification and low-level exercise testing within three weeks of acute MI to assess left ventricular function and arrhythmias 5
Medical Treatment
Medical treatment after MI includes:
- Beta blockers and angiotensin-converting enzyme (ACE) inhibitors to treat hypertension 4
- Statins to reduce serum low-density lipoprotein cholesterol to <70 mg/dl 4
- Aspirin or clopidogrel to prevent recurrent MI 3, 5
- Long-acting nitrates as antianginal and antiischemic drugs 4
- Digitalis for treating congestive heart failure only if deemed absolutely necessary 5
Rehabilitation and Lifestyle Modifications
Rehabilitation and lifestyle modifications after MI include:
- Cardiac rehabilitation to improve prognosis and reduce major adverse cardiac and cerebrovascular events (MACCE) 2
- Increased social support and decreased life stress to obtain an adaptive coping capacity for lifestyle change 6
- Control of coronary risk factors, including smoking cessation, healthy diet, and regular exercise 4, 5