Quality Care for Heart Attacks

The standard treatment plan for heart attacks includes:

• Aspirin within 24 hours
• Aspirin at discharge
• ACE inhibitor
• Beta blocker
• Advice for smokers on how to stop smoking.

The Centers for Medicare & Medicaid Services and Joint Commission for the Accreditation of Healthcare Organizations have determined that the treatments listed above are indicators of quality care for heart attacks. Look for and expect these treatments at the hospital.

Treating a heart attack

When you go to the hospital because of a heart attack, the hospital will provide some or all of the following treatments:

• Oxygen to help breathing
• Aspirin within 24 hours of entering the hospital. Studies show that taking aspirin early during a heart attack is associated with a 23 percent decreased chance of dying. (There may be a medical reason why some patients cannot have aspirin, so if you do not receive aspirin, ask your doctor about it.)
• Morphine to control pain.
• Thrombolytics to dissolve a blockage in the coronary arteries. These drugs are most effective when given within three hours after symptoms appear. Some thrombolytics are streptokinase, anistreplase, alteplase, reteplase, and heparin.
• Doctors will sometimes surgically remove the blockage from the artery.

Recovering from a heart attack

During your stay in the hospital, your doctor might prescribe one or more of the following treatments to relieve discomfort and ease the heart’s workload while it recovers.

• ACE inhibitors (angiotensin-converting enzyme inhibitors)—help open the arteries and lower blood pressure, improving blood flow.
• Beta blockers—help to improve blood pressure and may help prevent some heart rhythm problems.
• Nitroglycerin—widens arteries to improve blood flow.
• Angioplasty—a procedure that widens an artery by guiding a wire to the blocked area and expanding the walls of the artery. This improves blood flow to the heart to help it heal.

Leaving the hospital after a heart attack

After leaving the hospital, you will be advised to follow treatment instructions provided by your doctor or the hospital’s discharge planner to allow the heart to continue to heal. Treatments should include:

• Aspirin. When you are being discharged from the hospital, your doctor should instruct you on continuing to use aspirin at home. Using aspirin after a heart attack can decrease the chance of dying, of having another heart attack, and of having a stroke. If you do not receive instructions, ask your doctor about it. There may be a medical reason why you cannot have aspirin.
• Bed rest, initially.
• Proper diet.
• Modified daily activities at first, with a gradual increase in activities over three to six weeks.
• Advice to stop smoking if you are a smoker. By quitting smoking, a patient can slow damage to the heart arteries, thereby lowering the risk of future heart attacks and heart failure. The hospital staff may tell you about classes, group sessions, reading materials, or medications available to help you.
• Drugs such as:

• ACE inhibitors—commonly used ACE inhibitors are captopril, enalapril, lisinopril, ramipril, and fosinopril. (Not everyone can take ACE inhibitors, but you should ask your doctor about this if one is not prescribed for you.)

• Angiotensin-receptor blockers (ARB) which have an effect similar to ACE inhibitors.
• Diuretics—or “water pills" to keep fluid from building up in your body and lungs, which helps you breathe easier.
• Beta blockers. These help blood vessels around the heart to relax, thereby decreasing the heart’s workload. When a beta-blocker is used early in the course of a heart attack, or with continued use after the heart attack, it has been shown to significantly decrease the chance of death. (If you do not receive a beta blocker, ask the doctor. There may be a medical reason for not prescribing it, such as an allergy, a problem with low blood pressure, or problems with your heart rate or heart rhythm.)