A Post-Heart Attack Checklist

What Should Happen After a Heart Attack

After you've survived a heart attack (also called a myocardial infarction, or MI), you've got a lot to learn about and a lot to think about. While in the good old days you might have had a week or two of hospitalization to go through all the testing, risk assessment, education, and initiation of therapy necessary to optimize your long-term prognosis, today whatever is going to get done must happen in the first three (or four, if you've got a liberal health plan) days.

Doctors and hospitals have mobilized nicely to provide adequate acute care for the patient showing up with an acute MI. But too often, many have dropped the ball when it comes to giving appropriate care after those first critical hours. As a consequence, all too often patients don't receive all the assessments, education, and treatment they need to assure an optimal outcome. For instance, recent studies show that less than half the patients who need statin drugs receive them. Other studies show that only a minority of heart attack survivors receive beta blockers. And the proportion of patients who get an adequate assessment for the risk of sudden death, let alone those who receive the implantable defibrillator when it is indicated, is laughable.

The key to successfully navigating your way to a long, healthy life after a heart attack is you. You need to insist that the appropriate tests are done, the appropriate referrals are made, and the appropriate medications are begun. To this end, here is a convenient checklist of the things that should be done -- ideally before you even leave the hospital -- after your heart attack.

Doctors really do want to do the right thing. It's just that, given all the pressure and constraints they're operating under, from both insurance companies and the government, sometimes you need to remind them of who they're really obligated to, and what your expectations are in that regard.

The Post-Heart Attack Checklist:

1) Lifestyle changes and other education:

• I have been fully instructed on the warning signs and symptoms of heart attack, and the actions to take if I experience these signs or symptoms. (y/n) _____
• If I am a smoker, I have been counseled to stop, and referred to one or more smoking cessation programs. (y/n) _____
• I have been fully instructed on the American Heart Association Therapeutic Lifestyle Changes (or similar) diet. (y/n)_____
• I have received detailed activity instructions for the next 4-6 weeks, and have been referred to a cardiac rehabilitation program. (y/n) _____
• The importance of long-term exercise has been explained to me. (y/n) _____
• My doctor has talked to me about when I can resume sexual activity. (y/n) _____
• My doctor has talked to me about when I can resume driving. (y/n) _____

2) Assessing the risk of another heart attack in the near future:

• The status of my coronary arteries has been assessed by either stress/thallium study (y/n) _____ or cardiac catheterization. (y/n) _____
• The condition of my coronary arteries has been explained to me as follows: __________________________
• The plan for following the status of my coronary arteries over time is: __________________________

3) The amount of damage done to my heart has been assessed by:

• Stress/thallium study (y/n) _____
• Cardiac catheterization (y/n) _____
• MUGA scan (y/n) _____
• Echocardiogram (y/n) _____
• My ejection fraction is _______ (Note: if the ejection fraction is 35% or lower, see #6 below.)
• I (do / do not) have some degree of heart failure.

4) Important numbers I need to know:

• My lipid profile has been measured, and the results are: Total cholesterol _______ LDL cholesterol _______ HDL cholesterol _______ Triglycerides _______
• My blood pressure is _______
• My ejection fraction is _______

5) Names and doses of medications prescribed for me:

• Aspirin ___________________________
• Beta blocker ___________________________
• ACE inhibitor ___________________________
• Statin ___________________________
• Note: All of these medicines have been shown to help prevent further heart attacks and reduce the risk of death. If I have not received a prescription for one or more of these medications, the reason is ___________________________.

6) Preventing sudden death

• If my ejection fraction is 30% or less, (or if I have had heart failure, and my ejection fraction is 35% or less) I have been referred to an electrophysiologist to discuss the possibility of an implantable defibrillator on: ______ (date)
• Members of my family have been trained in CPR (y/n): ______

More On What You Need To Do After A Heart Attack:

• Preventing Another Heart Attack
• Preventing Heart Failure
• Preventing Sudden Death

_Sources:

_{Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.}