title: Myocardial infarction: management of the subacute period.
abstract: Optimal management of myocardial infarction in the subacute period focuses on improving the discharge planning process, implementing therapies early to prevent recurrent myocardial infarction, and avoiding hospital readmission. Evidence-based guidelines for the care of patients with acute coronary syndrome are not followed up to 25% of the time. Antiplatelet therapy, renin-angiotensin-aldosterone system inhibitors, beta blockers, and statins constitute the foundation of medical therapy. Early noninvasive stress testing is an important risk assessment tool, especially in patients who do not undergo revascularization. Discharge preparation should include a review of medications, referral for exercise-based cardiac rehabilitation, activity recommendations, education about lifestyle modification and recognition of cardiac symptoms, and a clear follow-up plan. Because nonadherence to medications is common in patients after a myocardial infarction and is associated with increased mortality risk, modifiable factors associated with medication self-discontinuation should be addressed before discharge. Structured discharge processes should be used to enhance communication and facilitate the transition from the hospital to the family physician's care.
authors.affiliation: Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, CA, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Mercado
authors.affiliation: Naval Hospital Guam, Agana Heights, Guam.
authors.forename: Dustin K
authors.initials: DK
authors.lastname: Smith
authors.affiliation: Navel Hospital Pensacola Family Medicine Residency Program, Pensacola, FL, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: McConnon
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003661:Decision Support Techniques; D037001:Directive Counseling; D005081:Exercise Therapy; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000628:therapy*; D010351:Patient Discharge; D018802:Patient-Centered Care / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D019467:Subacute Care / Q000379:methods*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors