Angiotensin receptor blockers should not be used in combination with ACE inhibitors. These agents should be continued indefinitely in patients without contraindications who have a left ventricular ejection fraction of 40% or less.ĪCE inhibitors should be administered early during hospitalization after an MI and should be continued indefinitely in patients without contraindications.Īngiotensin receptor blockers are indicated in all patients who have had an MI and are allergic to or cannot tolerate ACE inhibitors.
Structured discharge processes should be used to enhance communication and facilitate the transition from the hospital to the family physician's care.Īspirin (162 to 325 mg per day) should be given to all patients with suspected acute MI and continued indefinitely at a dosage of 75 to 162 mg per day upon discharge.Ĭlopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta) are recommended in combination with aspirin for a minimum of 12 months in patients receiving drug-eluting stents, and for up to 12 months in patients receiving bare metal stents.Ĭlopidogrel and ticagrelor are recommended for conservative medical management of MI in combination with aspirin (162 to 325 mg per day) for up to 12 months.Įarly administration of beta blockers is recommended during hospitalization after an MI. 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. 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. Early noninvasive stress testing is an important risk assessment tool, especially in patients who do not undergo revascularization. Antiplatelet therapy, renin-angiotensin-aldosterone system inhibitors, beta blockers, and statins constitute the foundation of medical therapy.
Evidence-based guidelines for the care of patients with acute coronary syndrome are not followed up to 25% of the time.
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.
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