Acute%20coronary%20syndromes%20w_out%20persistent%20st-segment%20elevation Patient Education

Patient and Caregiver Education

• Patient counseling tends to improve patient compliance and outcomes
• Assess the functional capacity and the ability to carry out daily activities or work of the patient
• Educate the patient and caregivers about unstable angina and cerebrovascular disease
  • Discuss the nature of the disease, drug regimens, lifestyle modifications and symptoms of angina
• Before hospital discharge, provide instructions with respect to medication type, purpose, dose, frequency and side effects
• Patient and caregivers should be instructed on what steps to take if anginal symptoms occur
  • Patient should be instructed to take sublingual nitrate and to seek emergency medical attention if 3 doses of nitrate fail to relieve pain
  • Explain to patient that if anginal symptoms change (eg pain more frequent, or occurs at rest, etc), they should contact their physician
• Education should be a part of every patient encounter and should be tailored to the patient’s level of understanding
  • May be best to develop a plan with the patient and hold discussions over time so that patient is not overwhelmed by changing several behaviors all at one time (eg smoking, diet, exercise, etc)
• Enlisting family members into the educational process to assist in achieving risk-factor modifications may be helpful
  • Eg cooking low-fat meals for the entire family or family exercise to further support the patient in changing risk behavior
  • Particularly important when screening of family members reveals common risk factors (eg hyperlipidemia, hypertension and obesity)
• Inform schedule for follow-up after discharge
  • Low-risk medically treated patients and revascularized patients should return in 2-6 weeks
  • Higher risk patients should return within 2 weeks
• Annual influenza vaccination is recommended
• Patient’s need for treatment of chronic musculoskeletal pain or discomfort should be assessed; pain relief should begin with Paracetamol, small doses of narcotics or nonacetylated salicylates
• Antioxidant vitamins (eg vitamin E, C or beta-carotene) and folic acid with or without vitamins B6 and B12, should not be used for secondary prevention in UA/NSTEMI patients

Activity

• Daily walking may be encouraged immediately after discharge
• Exercise training can be started within 1-2 weeks after PCI or CABG to relieve ischemia
• Discuss safety and timing of resumption of sexual activity
  • Usually 1-2 weeks for low-risk patients and 4 weeks for post-CABG
• Give advice on resumption of driving (usually 1 week) if stressful driving conditions are avoided
• Recommend timing of returning to work
• Air travel may resume within 2 weeks of discharge, if patient travels with companion, carries sublingual GTN and takes airport transport to avoid rushing

Smoking Cessation

• There are observational studies that show cigarette smoking increases the risk for CV disease events, insulin resistance and DM
  • Dose-dependent relationship exists between cigarettes smoked and CV risks
• Primary goal is complete smoking cessation
• Assess patient’s tobacco use and strongly urge patient and family to stop smoking
• Identify which patients are willing to quit
  • Quit plan should be developed and pharmacological therapy (eg nicotine replacement, Bupropion, Varenicline), counseling and formal cessation programs should be provided, if needed
• Aside from smoking cessation, avoidance of exposure to environmental smoke is also recommended