More of this Feature • Part 1: You've survived  1 day - Now what? • Part 2: What's supposed to happen? • Part 3:Preventing another heart attack • Part 4: Preventing heart failure • Part 5: Delaying CAD • Part 6: Preventing sudden death

Related Resources • Chest pain • Coronary artery disease • Heart attacks • Risk factors

After you’ve survived the first day of a heart attack, 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 presenting with a heart attack.  But for the most part they have completely neglected approaching the necessary subacute care (the care after the first 24 hours) in an organized fashion.  As a consequence, it is the rare patient who receives all the assessment, training, and treatment that has been shown to be vital to 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 who receive the implantable defibrillator – is laughable.

Until doctors and hospitals get their act together, the key to successfully navigating 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 we provide a convenient check list of the things that should be done prior to discharge after a 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, sometimes they need for their patients to remind them of who they’re really beholden to, and what the expectations in that regard truly are.

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