Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, CA, USA.
Naval Hospital Guam, Agana Heights, Guam.
Am Fam Physician. 2013 Nov 1;88(9):581-8.
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.
心肌梗死后亚急性期的最佳管理重点在于改善出院计划流程，尽早实施治疗以预防再次发生心肌梗死，并避免再次住院。遵循急性冠状动脉综合征患者护理的循证指南的比例不足 25%。抗血小板治疗、肾素-血管紧张素-醛固酮系统抑制剂、β受体阻滞剂和他汀类药物构成了药物治疗的基础。早期非侵入性应激测试是一种重要的风险评估工具，尤其是在未进行血运重建的患者中。出院准备应包括药物审查、推荐进行基于运动的心脏康复、活动建议、生活方式改变的教育以及对心脏症状的识别，以及明确的随访计划。由于心肌梗死后患者普遍存在不遵医嘱的情况，且与死亡风险增加相关，因此应在出院前解决与药物自行停药相关的可改变因素。应采用结构化的出院流程来加强沟通，并促进从医院到家庭医生护理的过渡。
