Protocol for Care after a Heart Attack (MI)

This protocol is based on the Newcastle guidelines for structured care after discharge with a heart attack. It has been developed jointly by hospital and general practice representatives.

After discharge following an MI

• Secondary prevention as appropriate
  • aspirin
  • beta blockers
  • ACE inhibitors (particularly if more than minimal heart damage)
  • statins for optimal cholesterol control (FATS guideline)
  • clopidogrel in some: usually limited duration of treatment (refer to local guidelines/specific specialist advice)
     
• GTN: all patients should have a supply
   
• Blood pressure control: optimised (refer to local guidelines)
   
• Blood sugar control: optimised in diabetics (refer to local guidelines)
   
• Warfarin in some (eg atrial fibrillation, for three months if high risk of left ventricle heart thrombus)
   
• Cardiac rehabilitation: check has been offered and attendance
   
• Risk factors: check if smoking (consider nicotine replacement treatment if motivated to quit), healthy eating, regular physical activity, weight (BMI), alcohol safe limits
   
• Patient and carer support: ensure appropriate information and education
   
• Ensure included on ischaemic heart disease register
   
• Review:
  • 1 week after discharge, check blood for kidney function if on ACE inhibitor treatment
  • 3-4 months post MI, check blood fat levels
  • thereafter, annual review if well
  • more frequent reviews may be needed eg if symptomatic, for risk factor reduction, drug monitoring and changes

Patients may be reviewed in hospital outpatients 6-12 weeks post MI at the discretion of the consultant cardiologist/physician.

Annual review for patients with IHD

• Symptoms and functional status review
  • How patients feel - physical and psychological
  • Angina severity, frequency and stability
  • Breathlessness and ankle oedema
  • Other symptoms
     
• Drug review
  • Concordance
  • Side effects
  • Check if any unnecessary or inappropriate drugs, including over the counter, alternative medicines
     
• Monitoring: kidney function, fat levels in blood, blood sugar. In some blood count and thyroid function (eg if new onset or worsening angina, if more breathless)
   
• Lifestyle and coronary risk factors: check if smoking (consider use of nicotine replacement if motivated to quit), healthy eating, regular exercise being sustained (exercise referral if appropriate), weight (BMI), alcohol safe limits, lipids (FATS guideline), high blood pressure (local guidelines)
   
• Identification of patients for further investigation and/or specialist referral. For example:
  • patients with new or worsening angina, or possible heart chest pain
  • management of arrhythmias
  • worsening heart failure
  (eg ECG, chest xray, specialist referral, possibly open access heart investigations if available)
   
• Patient and carer support: ensure appropriate information and education
   

August 2004