Clinical update
Myocardial infarction SCIENCE PHOTO LIBRARY
Essential facts Despite improvements in the number of people surviving a heart attack, heart disease remains the UK’s biggest killer, causing more than 103,000 deaths each year. Currently there are around one million men and nearly 500,000 women in the UK who have had a myocardial infarction (MI), and survivors run a considerably increased risk of having another. Shorter hospital stays mean GPs and nurses are increasingly responsible for secondary prevention, particularly the promotion of cardiac rehabilitation programmes and the prescription and monitoring of drug therapy.
What’s new
Causes/risk factors Heart attacks are usually caused by a blockage in the coronary artery, a preventable complication of coronary heart disease. As well as stopping smoking, other important ways of reducing risks are eating healthily, staying within safe limits of alcohol consumption, taking regular exercise and reaching and maintaining an ideal weight. Medication may also be prescribed to lower risks, including ACE inhibitors, antiplatelet therapy, beta blockers and statins.
Expert comment Kathryn Carver is cardiac rehabilitation lead nurse at Addenbrooke’s hospital in Cambridge
NURSING STANDARD
NICE clinical guideline 172 Myocardial Infarction: Secondary Prevention guidance.nice.org.uk/CG172 The British Heart Foundation publishes a variety of information on preventing heart disease www.bhf.org.uk
Treatment
The National Institute for Health and Care Excellence (NICE) has updated its clinical guidance on secondary prevention of MI, first published in 2007. This offers evidence-based advice for patients in both primary and secondary care who have had an MI. It includes new and updated recommendations on cardiac rehabilitation, lifestyle changes, drug therapy and communication of diagnosis and advice.
Find out more
Since the late 1990s the number of deaths caused by heart attacks have been reduced, largely due to changes in treatments given immediately alongside therapies to prevent further attacks, such as cardiac rehabilitation. The NICE guideline recommends that rehabilitation should begin before the patient is discharged from hospital, with a comprehensive programme including exercise, health education and stress management. Patients should be invited to attend a session within ten days of leaving hospital.
How you can help your patient Help patients to identify their individual risk factors, then discuss which ones they might consider changing. For example, the guideline recommends that people who have had a heart attack should eat a Mediterranean-style diet, with more bread, fruit, vegetables and fish, and less meat. Products based on plant oils should replace butter and cheese.
‘Addressing lifestyle risk factors and adhering to medication are the keys to slowing down the atherosclerotic process and preventing a further heart attack. Patients should be encouraged to carry on taking any prescribed medication, making sure they understand why they have been prescribed each of their medicines. Stopping smoking should be a priority.
British Association for Nursing in Cardiovascular Care www.bancc.org British Cardiovascular Society www.bcs.com Heart Research UK www.heartresearch.org.uk NHS Stop Smoking Service smokefree.nhs.uk Article from Nursing Standard: Acute coronary syndrome: diagnosis, risk assessment and management Marshall K (2011) Nursing Standard. 25, 23, 47-56. dx.doi.org/10.7748/ ns2011.02.25.23.47.c8329
Patients can be referred to smoking cessation services if they agree to try to quit. Being more active is also vital. Few people undertake enough general activity, which is as important as the “30 minutes of exercise, five times each week” message. Urge patients to attend a cardiac rehabilitation programme, which offers support in all these areas.’ january 8 :: vol 28 no 19 :: 2014 19
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Myocardial infarction SCIENCE PHOTO LIBRARY
Essential facts Despite improvements in the number of people surviving a heart attack, heart disease remains the UK’s biggest killer, causing more than 103,000 deaths each year. Currently there are around one million men and nearly 500,000 women in the UK who have had a myocardial infarction (MI), and survivors run a considerably increased risk of having another. Shorter hospital stays mean GPs and nurses are increasingly responsible for secondary prevention, particularly the promotion of cardiac rehabilitation programmes and the prescription and monitoring of drug therapy.
What’s new
Causes/risk factors Heart attacks are usually caused by a blockage in the coronary artery, a preventable complication of coronary heart disease. As well as stopping smoking, other important ways of reducing risks are eating healthily, staying within safe limits of alcohol consumption, taking regular exercise and reaching and maintaining an ideal weight. Medication may also be prescribed to lower risks, including ACE inhibitors, antiplatelet therapy, beta blockers and statins.
Expert comment Kathryn Carver is cardiac rehabilitation lead nurse at Addenbrooke’s hospital in Cambridge
NURSING STANDARD
NICE clinical guideline 172 Myocardial Infarction: Secondary Prevention guidance.nice.org.uk/CG172 The British Heart Foundation publishes a variety of information on preventing heart disease www.bhf.org.uk
Treatment
The National Institute for Health and Care Excellence (NICE) has updated its clinical guidance on secondary prevention of MI, first published in 2007. This offers evidence-based advice for patients in both primary and secondary care who have had an MI. It includes new and updated recommendations on cardiac rehabilitation, lifestyle changes, drug therapy and communication of diagnosis and advice.
Find out more
Since the late 1990s the number of deaths caused by heart attacks have been reduced, largely due to changes in treatments given immediately alongside therapies to prevent further attacks, such as cardiac rehabilitation. The NICE guideline recommends that rehabilitation should begin before the patient is discharged from hospital, with a comprehensive programme including exercise, health education and stress management. Patients should be invited to attend a session within ten days of leaving hospital.
How you can help your patient Help patients to identify their individual risk factors, then discuss which ones they might consider changing. For example, the guideline recommends that people who have had a heart attack should eat a Mediterranean-style diet, with more bread, fruit, vegetables and fish, and less meat. Products based on plant oils should replace butter and cheese.
‘Addressing lifestyle risk factors and adhering to medication are the keys to slowing down the atherosclerotic process and preventing a further heart attack. Patients should be encouraged to carry on taking any prescribed medication, making sure they understand why they have been prescribed each of their medicines. Stopping smoking should be a priority.
British Association for Nursing in Cardiovascular Care www.bancc.org British Cardiovascular Society www.bcs.com Heart Research UK www.heartresearch.org.uk NHS Stop Smoking Service smokefree.nhs.uk Article from Nursing Standard: Acute coronary syndrome: diagnosis, risk assessment and management Marshall K (2011) Nursing Standard. 25, 23, 47-56. dx.doi.org/10.7748/ ns2011.02.25.23.47.c8329
Patients can be referred to smoking cessation services if they agree to try to quit. Being more active is also vital. Few people undertake enough general activity, which is as important as the “30 minutes of exercise, five times each week” message. Urge patients to attend a cardiac rehabilitation programme, which offers support in all these areas.’ january 8 :: vol 28 no 19 :: 2014 19
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 21, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
