After a Heart Attack: Don't Wait for a Second (Part Four)



With all that has been learned about preventing and treating heart attacks, a.k.a. myocardial infarctions (MI), they are still the definition of a serious medical condition. Safe to say that nobody wants another one, and yet about 18 percent of survivors will be readmitted with a second one. So, in this fourth and final installment of our After a Heart Attack series, we want to share five steps you can take to prevent a second.

1. Take Your Medications

Medication is an important part of post-MI treatment, especially if yours was due to atherosclerosis, for which cholesterol-lowering medication would be prescribed. Most survivors should also take a baby aspirin every day, and if you’ve had a stent, an additional anticoagulant medication like prasugrel, ticagrelor or clopidigrel will be prescribed to prevent clots from forming inside the stent. Taking aspirin along with one of these prescribed medications is known as dual antiplatelet therapy (DAPT).

Because most survivors have high blood pressure, they will usually be prescribed at least one medication to control it. But even without hypertension, medications such as ACEI and beta blockers that lower blood pressure may be recommended due to the damage to the heart. If you have other conditions, such as diabetes, there will be still more medications to manage.

Often patients are going from no medication to having a regimen of six or more, which may seem daunting, but may be what it takes to minimize your risk. Patients should be mindful of the many interactions that can occur when taking multiple medications. Some over-the-counter medications can even create problems. The more complicated the drug prescription, the easier it is to miss doses, miss refills or just simply be overwhelmed. Here are a few suggestions to help:

Create a medication map. A chart that organizes all your medication in one place so you or a caregiver can see at a glance what, when and how much.

Schedule a “brown bag” session with your doctor or pharmacist. Put all your prescription and nonprescription medications in a bag and take them to your doctor’s office or pharmacy for evaluation. They may find overlapping or duplicate prescriptions. This is also a good time to make or update your medication map. Periodic reviews allow you to ask if simpler, less expensive or better alternatives are available.

Tell the truth about costs. If you’re having trouble paying for your medications, tell your healthcare team, they may be able to find medications that are affordable and within your health plan. There are other ways to help manage prescription costs as well.

Gather tools and support. Life gets busy. At first your medication may be the highest priority, but as you get further from the event, other priorities arise. But taking care of your health is key to being able to take care of all your priorities. To help stay on track with your medicines:

  • Use a weekly pill box.
  • Cue pill taking with some other activity, such as eating.
  • Find a smartphone app that lets you schedule automatic reminders.
  • Ask your family to help you remember.
  • If yours is a complicated treatment plan, ask your medical team if it can be simplified.

2. Follow-up With Your Doctor

An important step is to make — and keep — a follow-up appointment with your cardiologist within a week of discharge, if possible. Of primary interest is how you are tolerating your medications.

Don’t come to this appointment empty handed. Write down any questions you have about your treatment plan, because unanswered questions can lead to doubts that may lead to not following the plan. Your doctor will want to know any symptoms you are having so they can either reassure you it’s nothing serious, or so they can monitor the situation. So pay close attention to anything going on with your body, jot down notes about them and be sure to mention them to your doctor at your follow-up. Some examples of things the doctor may ask about or would need to know include: Are there medication side effects? Anticoagulants and antiplatelet drugs can cause bleeding, and blood in the stool can be a symptom. Are you short of breath or are your ankles swollen?

Heart attack survivors may become acutely concerned with any pain in their chest. Most chest pain does not indicate a heart attack, but how do you know? Rule of thumb: Another heart attack will feel similar to the first one — heaviness, tightness, pressure, burning, an ache that’s more diffused and that typically lasts minutes or longer, and gets worse with exertion and better with rest. If it’s a sharp pain, if it’s focal, if it’s transient, lasting only seconds, it’s not likely your heart.

3. Participate in Cardiac Rehabilitation

Cardiac rehab is a medically supervised program designed to help you recover and strengthen the muscle that is your heart. Very likely you received a referral to cardiac rehab when you were discharged. If you didn’t, ask your doctor about it. It’s much more than just working out at the gym.

It involves four phases, and Phase I begins in the hospital and involves getting you up and moving as soon as possible. Most patients are out of bed within the first 24 hours.

Phase 2 begins after discharge. Typically, it’s done in a gym, at a hospital or rehab facility and is overseen by a cardiologist. These facilities are staffed by certified preventive and rehabilitative exercise specialists as well as nurses. An exercise physiologist creates a personalized exercise prescription followed by training in groups with other patients. Your heart rate, blood pressure and EKG are constantly monitored. Phase 2 usually consists of one-hour sessions three times a week for 12 weeks. In addition to being monitored, you learn how to check your heart rate and evaluate your workout intensity. Over the 12 weeks, you work up to more intense and longer aerobic activity on a treadmill or exercise bike. Generally, before or after you work out, there are counseling and educational sessions to help you understand the nutritional and other lifestyle adjustments needed for optimal health. Phase 2 is covered by Medicare and most other insurers.

Phase 3 is in a supervised setting, like a rehab center, but some of the monitoring is removed. It can be as short as a couple of weeks, but can be longer depending on your condition.

In Phase 4, you are unsupervised and unmonitored, typically still in a rehab center, but sometimes it may be in a community center or YMCA. This is the way to maintain your gains, practice what you have learned in rehab and prevent another heart attack. Think of this as being for the rest of your life.

In addition to the strength and education components of cardiac rehab, most survivors find the social support to be equally important.

4. Manage Risk Factors

If you’ve had a heart attack, take action to reduce the risk of another. Some risk factors — age, gender, family history and race — cannot be changed. That makes managing those that can be changed — smoking, high cholesterol, high blood pressure, obesity, physical inactivity and diabetes — all the more important.

Most heart attacks are the result of risk factors such as high cholesterol, hypertension or diabetes, which can be impacted by a healthy diet and regular physical activity. The American Heart Association has many tools and resources to support you in making the beneficial changes to reduce your risk.

For some people, diet and exercise are not enough to reduce their numbers. A third part of managing risk factors includes medication. If you have been prescribed medication for risk management, be committed to taking it exactly as prescribed. Unless used as directed, it cannot work as expected.

5. Get Support

People usually have a spectrum of emotions after a heart attack, but one of them is not “No big deal.” Common feelings include fear, anxiety, anger, loneliness — but also hope for the future as well as relief at having another chance. Depression occurs in about 20 percent of survivors.

Getting emotional support will improve your recovery. Family support makes a difference, especially when they help you make better choices. Community support through churches, synagogues and mosques may also be available. These connections provide relationships with others who can help hold you to account and celebrate your successes with you.

Finding support with peers who have experienced heart attack may also help. This is one of the many benefits of completing a cardiac rehabilitation program. You may also find the AHA’s Support Network helpful. The Support Network is a valuable and easy-to-use social media platform designed to support the emotional needs of survivors and their loved ones.

There have been great advances in cardiac care. Most people — about 86 percent — who have a heart attack will survive, so the pertinent question is what will you do next? Have another “event” or lead an “event-less” life? About 18 percent of survivors are readmitted. You can certainly improve your chances of recovery and avoid readmissions by taking the recommended actions of your medical team seriously and sticking to them. These five actions help put you in charge of your recovery.

Editor’s Note: Traci Joyce of Hawaii lost 30 percent of her heart to a heart attack, but thanks to her diligent attention to these elements of recovery, she is thriving. Read her story.

See our entire After a Heart Attack series:

What Happens Now? (Part One)

Up & At 'Em! Cardiac Rehab Makes a Big Difference (Part Two)

Feelings After a Heart Attack (Part Three)

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