Why Follow-Up Care Is Key to Recovery After Your Heart Attack

Clear instructions help patients after a hospital stay

When you’re released from the hospital after you’ve had a heart attack, you probably think you’re on the road to recovery. And you are. But now comes a crucial time when you need to follow your doctor’s instructions faithfully and watch for any signs of trouble.

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“The key message for patients to understand is that their risk for problems and their need for care does not end when they are discharged,” says cardiologist Umesh N. Khot, MD , Vice Chairman of Cardiovascular Medicine at Cleveland Clinic. “There is a high risk of having additional problems in the first couple of weeks, and they need to have a heightened awareness.”

Hospital discharge routines are changing

Heart attack patients used to leave the hospital with vague, verbal instructions for follow-up medical care, often given as they headed out the door.

Today, in part because of research, many hospitals offer careful instructions to patients who are going home. You may receive written, detailed directions aimed at preventing medical emergencies that can land you back in the hospital. Family members or caregivers are included in the conversation.

Dr. Khot led a large, single-center analysis of heart-attack related patient discharges at Cleveland Clinic.

Dr. Khot and his colleagues reviewed records for all patients who went home from Cleveland Clinic’s main campus with a principal diagnosis of a heart attack between April 2008 and June 2012.

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Of the 3,069 patients researchers analyzed:

  • One in six patients (16 percent) were readmitted to the hospital within three months of discharge
  • Of those readmitted, 47 percent were back in the hospital because of heart attack-related or cardiovascular-related issues
  • 39 percent of the re-admissions occurred very early — within 15 days —after discharge

“We found that both the risk and primary cause of readmission changed markedly over time,” says co-author Michael J. Johnson, MD, an interventional cardiology fellow at Cleveland Clinic. “These findings contrast with earlier studies that suggest the causes of readmission after a heart attack did not vary substantially over time.”

This is one of the first investigations to evaluate the risk and cause of readmission in the second and third months following discharge after a heart attack, Dr. Johnson says. The study showed that readmission risk during this time was substantially lower than in the first month after discharge and remained relatively constant.

These findings were recently published as a letter in the Journal of the American College of Cardiology. In the meantime, the study’s findings have prompted significant improvements in Cleveland Clinic’s discharge procedures for heart attack patients, Dr. Khot says.

Planning ahead while you’re still in the hospital

In the past, patients often left the hospital unsure of which doctor to follow up with. Should they call their primary doctor if they have a problem? Or did they need to track down the hospital cardiologist? Now, discharge planning begins right after you’re admitted to the hospital.

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Medical staff members will look for cardiac rehabilitation programs for the patient. And it’s now likely that you will schedule follow-up appointments with your doctors while you’re still in the hospital. You typically will meet with a nurse practitioner in a week, and a cardiologist within four weeks. Cardiac rehab usually begins about two weeks after you go home.

The most important thing you can do after coming home to prevent going back to the hospital is to take your medications, Dr. Khot says.

It’s OK to celebrate the fact that you’re going home after having a heart attack. But it’s also good to understand that there is still work to be done, and that you must take an active role in reclaiming your health.

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