ST elevation myocardial infarction cardiac rehabilitation: Difference between revisions

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{{Infobox_Disease |
__NOTOC__
  Name          = Myocardial infarction|
{{ST elevation myocardial infarction}}
  DiseasesDB    = 8664 |
  ICD10          = {{ICD10|I|21||i|20}}-{{ICD10|I|22||i|20}} |
  ICD9          = {{ICD9|410}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000195 |
  eMedicineSubj  = med |
  eMedicineTopic = 1567 |
  eMedicine_mult = {{eMedicine2|emerg|327}} {{eMedicine2|ped|2520}} |
  MeshID        = |
}}
{{SI}}
{{WikiDoc Cardiology Network Infobox}}
{{CMG}}
{{CMG}}


'''Associate Editor:''' {{CZ}}
==2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT) <ref name="pmid15289388">{{cite journal| author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al.| title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). | journal=Circulation | year= 2004 | volume= 110 | issue= 5 | pages= 588-636 | pmid=15289388 | doi=10.1161/01.CIR.0000134791.68010.FA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289388  }} </ref><ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>==


{{Editor join}}
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Cardiac rehabilitation/secondary prevention programs, when available, are recommended for patients with [[STEMI]], particularly those with multiple modifiable [[risk factor]]s and/or those moderate- to high-risk patients in whom supervised exercise training is warranted. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' For all patients, it is recommended that risk be assessed with a physical activity history and/or an exercise test to guide prescription. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' For all patients, encouraging 30 to 60 minutes of moderate-intensity aerobic activity is recommended, such as brisk walking on most preferably all days of the week, supplemented by an increase in daily lifestyle activities (e.g., walking breaks at work, gardening, and household work). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


===[[Cardiac Rehabilitation:Patient information | Patient information for Cardiac Rehabilitation click here]]===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Encouraging resistance training 2 days per week may be reasonable. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


==Overview==
==2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid23247303">{{cite journal |author=O'Gara PT, Kushner FG, Ascheim DD, ''et al.'' |title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=Circulation |volume= |issue= |pages=|year=2012 |month=December |pmid=23247303 |doi=10.1161/CIR.0b013e3182742c84|url=}}</ref>==
===Posthospitalization Plan of Care (DO NOT EDIT)<ref name="pmid23247303">{{cite journal |author=O'Gara PT, Kushner FG, Ascheim DD, ''et al.'' |title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=Circulation |volume= |issue= |pages=|year=2012 |month=December |pmid=23247303 |doi=10.1161/CIR.0b013e3182742c84|url=}}</ref>===


'''Cardiac rehabilitation''' is a multidisciplinary service which requires close cooperation, adequate level of knowledge and skills. A comprehensive cardiac rehabilitation program should be considered in all patients after [[acute myocardial infarction]], [[coronary artery bypass surgery]] and [[Percutaneous Coronary Intervention (PCI): Basic Principles and Guidelines | percutaneous coronary angioplasty]]. Furthermore, all patients with [[coronary artery disease]] should receive a personal written invitation to attend a cardiac rehabilitation program. <ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
{|class="wikitable"
 
|-
 
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
==Essentials of Cardiac Rehabilitation==
|-
 
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Posthospital systems of care designed to prevent hospital readmissions should be used to facilitate the transition to effective, coordinated outpatient care for all patients with [[STEMI]].<ref name="pmid8185149">{{cite journal |author=Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M |title=Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial |journal=Ann. Intern. Med. |volume=120 |issue=12 |pages=999–1006 |year=1994 |month=June |pmid=8185149 |doi= |url=}}</ref><ref name="pmid17000937">{{cite journal |author=Coleman EA, Parry C, Chalmers S, Min SJ |title=The care transitions intervention: results of a randomized controlled trial |journal=Arch. Intern. Med. |volume=166 |issue=17 |pages=1822–8 |year=2006 |month=September |pmid=17000937 |doi=10.1001/archinte.166.17.1822 |url=}}</ref><ref name="pmid14581307">{{cite journal |author=Young W, Rewa G, Goodman SG, ''et al.'' |title=Evaluation of a community-based inner-city disease management program for postmyocardial infarction patients: a randomized controlled trial |journal=CMAJ |volume=169 |issue=9 |pages=905–10 |year=2003 |month=October |pmid=14581307 |pmc=219623 |doi= |url=}}</ref><ref name="pmid19189907">{{cite journal |author=Jack BW, Chetty VK, Anthony D, ''et al.'' |title=A reengineered hospital discharge program to decrease rehospitalization: a randomized trial |journal=Ann. Intern. Med. |volume=150 |issue=3 |pages=178–87 |year=2009 |month=February |pmid=19189907 |pmc=2738592 |doi= |url=}}</ref><ref name="pmid15381518">{{cite journal |author=Lappé JM, Muhlestein JB, Lappé DL, ''et al.'' |title=Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program |journal=Ann. Intern. Med. |volume=141 |issue=6 |pages=446–53 |year=2004 |month=September |pmid=15381518 |doi= |url=}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
The main goals of cardiac rehabilitation programs are to prevent further cardiovascular events by empowering patients to initiate
|-
and maintain lifestyle changes, improve quality of life through the identification and treatment of psychological distress and facilitate the patient's return to a full and active life by enabling the development of their own resources.
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Exercise-based cardiac rehabilitation/secondary prevention programs are recommended for patients with STEMI.<ref name="pmid15668354">{{cite journal |author=Leon AS, Franklin BA, Costa F, ''et al.'' |title=Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation |journal=Circulation |volume=111 |issue=3 |pages=369–76 |year=2005 |month=January |pmid=15668354 |doi=10.1161/01.CIR.0000151788.08740.5C |url=}}</ref><ref name="pmid19555836">{{cite journal |author=Suaya JA, Stason WB, Ades PA, Normand SL, Shepard DS |title=Cardiac rehabilitation and survival in older coronary patients |journal=J. Am. Coll. Cardiol. |volume=54 |issue=1 |pages=25–33 |year=2009 |month=June |pmid=19555836 |doi=10.1016/j.jacc.2009.01.078 |url=}}</ref><ref name="pmid15121495">{{cite journal |author=Taylor RS, Brown A, Ebrahim S, ''et al.'' |title=Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials |journal=Am. J. Med. |volume=116 |issue=10 |pages=682–92 |year=2004 |month=May |pmid=15121495 |doi=10.1016/j.amjmed.2004.01.009 |url=}}</ref><ref name="pmid21576654">{{cite journal |author=Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ |title=Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community |journal=Circulation |volume=123 |issue=21 |pages=2344–52 |year=2011 |month=May |pmid=21576654 |doi=10.1161/CIRCULATIONAHA.110.983536 |url=}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
|-
All patients should be referred to comprehensive cardiac rehabilitation irrespective of age. Women's needs should be addressed in comprehensive cardiac rehabilitation programs
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' A clear, detailed, and evidence-based plan of care that promotes medication adherence, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with interventions for [[secondary prevention]] should be provided to patients with STEMI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
Cardiac rehabilitation is an essential and the most important part of secondary prevention of cardiovascular diseases. The main components of a cardiac rehabilitation program are as follow: <ref> Hurst's The Heart, Fuster V, 12th edition, 2008 </ref> <ref>Mayo Clinic's Cardiology, A Concise Textbook of Cardiology, 3rd edition, 2007</ref> <ref>Topol's Textbook of Cardiovascular Medicine, Topol E, 3rd edition, 2007</ref><ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Encouragement and advice to stop [[smoking]] and to avoid secondhand smoke should be provided to patients with STEMI.<ref name="pmid10761958">{{cite journal |author=Wilson K, Gibson N, Willan A, Cook D |title=Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies |journal=Arch. Intern. Med. |volume=160 |issue=7 |pages=939–44 |year=2000 |month=April |pmid=10761958 |doi= |url=}}</ref><ref name="pmid12800128">{{cite journal |author=Thomson CC, Rigotti NA |title=Hospital- and clinic-based smoking cessation interventions for smokers with cardiovascular disease |journal=Prog Cardiovasc Dis |volume=45 |issue=6 |pages=459–79 |year=2003 |pmid=12800128 |doi=10.1053/pcad.2003.YPCAD15 |url=}}</ref><ref name="pmid18852396">{{cite journal |author=Dawood N, Vaccarino V, Reid KJ, Spertus JA, Hamid N, Parashar S |title=Predictors of smoking cessation after a myocardial infarction: the role of institutional smoking cessation programs in improving success |journal=Arch. Intern. Med. |volume=168 |issue=18 |pages=1961–7 |year=2008 |month=October |pmid=18852396 |doi=10.1001/archinte.168.18.1961 |url=}}</ref><ref name="pmid20854949">{{cite journal |author=Shah AM, Pfeffer MA, Hartley LH, ''et al.'' |title=Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalization associated with smoking status following myocardial infarction with left ventricular dysfunction |journal=Am. J. Cardiol. |volume=106 |issue=7 |pages=911–6 |year=2010 |month=October |pmid=20854949 |doi=10.1016/j.amjcard.2010.05.021 |url=}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
 
|}
*'''A'''=[[Aspirin]] use
*'''A'''=Anti anginal therapy
*'''B'''=[[Beta blocker]] use
*'''B'''=Blood pressure control
*'''C'''=Cholesterol lowering therapy
*'''C'''=Cigarette smoking cessation
*'''D'''=[[Diabetes Mellitus]] control
*'''D'''=Diet
*'''E'''=Exercise
*'''E'''=Education (patient and family education)
 
==Members of an ideal cardiac rehabilitation program==
 
#Cardiologists
#Neurologists
#Endocrinologists
#Nephrologists
#Internists
#General practitioners
#Independent practitioner associations (IPAs) and primary health organisations (PHOs)
#Primary health care nurses
#Cardiac rehabilitation nurses
#Cardiac Society members
#Disease state management nurses
#Exercise physiologists
#Dietitians
#Cardiac rehabilitation club representatives
#Medical and nursing colleges
#Health insurance policy makers and/or representatives
#Government (Ministry of Health) representatives
 
==Inpatient Rehabilitation==
 
The term inpatient rehabilitation refers to early initiation of rehabilitation program during entire hospitalization period. This stage is for patients hospitalized for heart disease. This time frame focuses on education and safe progression of activity.
 
*Early mobilization of patient
*Patient and family education regarding heart disease and risk factor modification: Spouse, partner and family members should be offered access to an appropriate support group and be involved in all stages of the [[Cardiac Rehabilitation|cardiac rehabilitation]] process
*Arranging evaluation for cardiac rehabilitation program following discharge
 
==Outpatient Rehabilitation==
 
[[Cardiac Rehabilitation|Cardiac rehabilitation]] programs should be offered within the primary care setting for which workforce development is required. Moreover this, rural patients need options for [[Cardiac Rehabilitation|cardiac rehabilitation]] at their home or within a primary care setting.  
 
===Psychosocial Management===
* Assessment of level of social support needed
* Monitoring symptoms of depression and anxiety
* Advice on return to vocational activity, driving and return to sexual activity
* Referral to home or hospital based comprehensive cardiac rehabilitation program
 
===Smoking Cessation===
 
====Assessment of tobacco use====
 
Regardless of its daily use, smoking should be stopped immediately.
 
====Strongly encouraging patient and family to stop smoking and avoid smoke====
 
This is one of the main parts of [[angina pectoris|chronic stable angina pectoris]] management. Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home is recommended.
 
For an ideal smoking cessation program; a physician should '''ask''' and '''advise''' to stop smoking, '''assess''' the progress, guide or help to get an '''assistance''' to quit and '''arrange''' a special '''aid''' for her/his patents to stop smoking).
 
After detailed evaluation, a [[nicotine replacement therapy]] (NRT) or sustained release bupropion (SRB) should also be administered when necessary.
 
The cardiovascular effects of [[nicotine]], such as increases in heart rate with small rises in blood pressure, have provoked some concerns about the use of [[nicotine replacement therapy]] in patients with [[coronary artery disease]]. However, [[nicotine]] patches have been used successfully in heart disease patients without any adverse effects. Similarly, after initial and detailed evaluation for its contraindications, it is suggested that [[nicotine replacement therapy]] may be initiated as early as 2–3 days after [[acute myocardial infarction]] and that it may be used in all patients with [[angina pectoris | stable angina pectoris]] and [[cardiac arrhythmias]].<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
 
====Facilitation of counseling, pharmacotherapy (such as [[nicotine replacement therapy]] and [[antidepressants]]) and cessation programs as appropriate====
 
[[Nicotine replacement therapy]] should be applied under a specialist's control. Contraindications to [[nicotine replacement therapy]] may include hypersensitivity to [[nicotine]], recent [[myocardial infarction]] with any complications, [[unstable angina | unstable angina pectoris]] or [[unstable angina | progressive angina]], [[Prinzmetal's angina]] and [[arrhythmias | severe cardiac arrhythmias]].
 
===Exercise Programs===
 
Vigorous exercise may trigger an [[acute myocardial infarction]] or [[sudden cardiac death]] but regular exercise protects against to these disorders. Case crossover studies suggest the risk of [[acute myocardial infarction]] is on average 6 times higher during and for 1 hour after vigorous exercise. This relative increase in risk of fatal cardiac events is much greater in sedentary individuals and less for those who exercise regularly. <ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
 
The risk of an acute cardiac event increases by up to 100-fold during vigorous exercise in individuals with underlying [[coronary artery disease]]. Similar studies also suggest the risk of [[sudden cardiac death]] is also higher during vigorous exercise especially for the normally individuals with [[sedentary life style]]. However, performed clinical trials of exercise based [[Cardiac Rehabilitation | cardiac rehabilitation]] suggest an overall benefit from regular exercise in low to moderate risk patients after [[acute myocardial infarction]], implying the increase in risk during and after vigorous exercise is likely to be balanced by a lower, long-term cardiovascular risk with specialist controlled, regular moderate exercise.<ref>Cardiac Rehabilitation, Summary and Resource Kit, New Zealand Guidelines Group (NZGG) Published in 2002 and reviewed in 2005 ISBN: 0-473-08826-6</ref>  <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>  <ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
 
====Assessment of exercise risk, preferably with exercise test to guide prescription====
 
Cardiovascular risk is much higher in patients with [[Heart Failure | impaired left ventricular function]], severe [[coronary artery disease]] with inducible [[myocardial ischemia]], [[Acute myocardial infarction | recent myocardial infarction]] and in patients with [[arrhythmia | severe ventricular arrhythmias]]. Excessive and vigorous exercise programs are not recommended in these patients although reliable evidence on the balance of risks and benefits is limited. The risks of exercise may be reduced by assessing risk prior to exercise training, by recommending low to moderate intensity activity at the beginning, and for patients at moderate or higher risk, by exercising initially in a formal [[Cardiac Rehabilitation | cardiac rehabilitation]] program.
 
====Exercise program of low to moderate intensity====
 
Initiation of regular and controlled physical activity of 30 to 60 minutes, 7 days per week (minimum 5 days per week) is strongly recommended.
 
All patients should be encouraged to obtain 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking and swimming. These exercises may be supplemented by an increase in daily activities (such as walking breaks at work, gardening or household work).
 
The patient’s risk should be carefully assessed with a physical activity history. Where appropriate, an exercise test is useful to guide the exercise prescription.
 
====Patient education regarding cardioprotective dietary pattern====
 
In all patients with cardiovascular disease, the adoption of a cardioprotective dietary pattern is strongly recommended.
 
This dietary pattern includes large servings of fresh fruit, fresh vegetables and whole grains, low fat dairy products, small servings of unsalted nuts and seeds regularly and fish or legumes frequently in place of fatty meat and full fat dairy products.
 
Small lean meat servings can be part of this dietary pattern.
 
Blood pressure increases after [[caffeine]] intake, but the increase is not clinically significant until 400 mg of [[caffeine]] (i.e., 2 to 4 cups of coffee, depending on strength and brewing method) is ingested.
 
====Advice on alcohol consumption====
 
There is no evidence of benefit with any amount of alcohol consumption on prevention of cardiovascular disease. Limit alcohol intake to 2 drinks a day for men and 1 drink a day for women.<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>  <ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
 
====Individually planned nutritionally balanced diet for overweight or obese patients====
 
*Advice to a patient to encourage a high intake of fruits and vegetables (5 to 9 servings/day).
*Suggest to a patient to eat grain products, with an emphasis on whole grains (≥6 servings/day).
*Suggest to a patient to eat at least 2 servings of fish per week
*Limit total fat intake in patients diet to <30% and saturated fat to <7% of energy. <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
 
Replace dietary saturated fats and trans fatty acids with monounsaturated and polyunsaturated fats (including foods rich in [[Omega-3 fatty acid | omega-3 fatty acids]]).
 
Food sources of [[Omega-3 fatty acid | omega-3 fatty acids]] include fatty fish (such as salmon), flaxseed and flaxseed oil, soybean oil, canola oil, and nuts.
 
*Limit amounts of dairy products to 2 to 4 servings of low fat or fat free items per day.
 
===Pharmacotherapy===
 
All medications will require consideration of side effects and contraindications. Using of [[Sildenafil]], [[Tadalafil]] and [[Vardenafil]] is contraindicated for patients receiving any form of nitrate therapy. Their chronic use may cause hearing loss.<ref>[http://www.fda.gov  Food and Drug Administration]</ref> Treatment with these drugs should be stopped at least 48-72 hours before starting the nitrate therapy. <ref name="pmid9935041">{{cite journal |author=Cheitlin MD, Hutter AM, Brindis RG, ''et al'' |title=ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association |journal=J. Am. Coll. Cardiol. |volume=33 |issue=1 |pages=273–82 |year=1999 |month=January |pmid=9935041 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109798006561}}</ref>
 
====Lipid lowering medications====
 
*Fasting lipid profile
*Drug therapy ([[statin]] generally most appropriate; consider adding [[fibrate]] if low [[high-density lipoprotein]] [[High density lipoprotein | HDL]] or high [[triglycerides]]). Interaction between [[statins]] and [[NSAIDs]] (e.g. [[Diclofenac|diclofenac sodium]]) and effect of grapefruit juice should be kept in mind.
 
The cornerstones of anti-lipid therapy and management<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>;
 
*If baseline [[LDL|LDL-Cholesterol]] is ≥100 mg/dL, [[LDL]] lowering drug therapy should be initiated in addition to therapeutic lifestyle changes. When [[LDL]] lowering medications are used in high risk or moderately high risk persons, it is recommended that intensity of therapy be sufficient to achieve a 30% to 40% reduction in [[LDL|LDL-Cholesterol]] levels.
*If baseline [[LDL|LDL-C]] is 70 to 100 mg/dL, it is reasonable to treat [[LDL|LDL-C]] to <70 mg/dL. If on-treatment [[LDL|LDL-C]] is ≥100 mg/dL, [[LDL]] lowering drug therapy should be intensified.
*If [[Triglycerides]] are 200-499 mg/dL, the sum of non–[[HDL Cholesterol]] levels should be <130 mg/dL. Moreover this, further reduction of non–[[HDL Cholesterol]] to <100 mg/dL is reasonable, if [[Triglycerides]] are ≥200 to 499 mg/dL.
*Therapeutic options to reduce non–[[HDL Cholesterol|HDL-C]] are: ’’’[[Niacin]]”’ can be useful as a therapeutic option to reduce non–[[HDL Cholesterol|HDL-C]] (after [[LDL|LDL-C]] lowering therapy) or ’’’[[Fibrate]]”’ therapy as a therapeutic option can be useful to reduce non–[[HDL Cholesterol|HDL-C]] (after starting to [[LDL|LDL-C]]–lowering therapy).
*If [[Triglycerides]] are ≥500 mg/dL, therapeutic options to lower the [[Triglycerides]] to reduce the risk of [[pancreatitis]] are [[fibrate]] or [[niacin]]; these should be initiated before [[LDL|LDL-Choesterol]] lowering therapy. The goal is to achieve non–[[HDL Cholesterol|HDL-C ]]<130 mg/dL if possible.
*If [[LDL|LDL-Cholesterol]] <70 mg/dL is the chosen target, consider drug titration to achieve this level to minimize side effects and cost of therapy. When [[LDL|LDL-Cholesterol]] level of <70 mg/dL is not achievable because of high baseline [[LDL|LDL-Cholesterol]] levels, it is generally possible to achieve reductions of >50% in [[LDL|LDL-Cholesterol]] levels by either statins or any other [[LDL|LDL-Cholesterol]] lowering drug combinations.
*Treatment with anti lipid drug combinations is beneficial for patients on lipid lowering therapy who are unable to achieve [[LDL|LDL-Cholesterol]] <100 mg/dL.
 
====Blood pressure control====
 
Recommended blood pressure should be ≤140 mm Hg or ≤130/80 mm Hg for patients with [[diabetes mellitus]] and [[chronic kidney disease]]. For hypertensive patients with well established [[coronary artery disease]], it is useful to add blood pressure medication as tolerated, treating initially with [[beta blockers]] and/or [[ACE inhibitors]], with addition of other drugs as needed to achieve target blood pressure.
 
====Lifestyle modification and regular assessments====
 
====Addition of blood pressure medication individualized to patient characteristics====
 
*Limit sodium intake to 6 grams per day
*Anger management: Consider and advice to control stress and use relaxation techniques. Many clinicians believe that relaxation techniques help alleviate feelings of stress, which is often a contributing factor to heart disease, and relieve [[chest pain]]. Such practices might include the use of meditation, progressive muscle relaxation, breathing exercises, yoga, self-hypnosis, or biofeedback.
*Increase physical activity within the patient’s limitation.
 
===Antiplatelet agents===
 
*[[Aspirin]] indefinitely [if [[aspirin]] contraindicated, consider [[warfarin]] or thienopyridine derivatives [(e.g. [[ticlopidine]], [[clopidogrel]])]
 
===Beta blockers===
 
[[Beta blocker]] therapy is definitely essential unless contraindicated.
 
===ACE inhibitors===
 
[[ACE inhibitor | Angiotensin-converting enzyme (ACE) inhibitors]]: ACE inhibitor therapy indefinitely in high-risk, post [[myocardial infarction]] patients ([[Acute myocardial infarction | anterior myocardial infarction]], [[Acute myocardial infarction | previous myocardial infarction]], [[Heart failure | left ventricular dysfunction]] or [[congestive heart failure]])
 
====Chronic therapy in other diseases and conditions====
*Controlling of other concomitant disorders such as [[diabetes mellitus]], [[hypertension]], [[kidney diseases]] and [[anemia]] is essential, related medication should applied in close cooperation with related specialist and should not be interrupted.
*[[Diabetes mellitus | Diabetes]] management should include lifestyle modification and measures to achieve [[HbA1c]] (glucohemoglobin) in normal range.
 
==Long Term Maintenance==
 
This is a maintenance program that provides a safe and enjoyable atmosphere for individuals who have completed phase II (outpatient based rehabilitation) and wish to continue on with their lifestyle choices and changes adopted during their phase II program.
 
*Patients with [[diabetes mellitus]] and [[kidney disease|kidney disorders]] warrant priority for [[Cardiac Rehabilitation | cardiac rehabilitation]].
*Comprehensive [[Cardiac Rehabilitation | cardiac rehabilitation]] programs should include vocational guidance to facilitate an appropriate and realistic return to work.
*For patients who see work as a potential barrier to participation in an outpatient based program, options such as home based cardiac rehabilitation should be considered.
*Comprehensive [[Cardiac Rehabilitation | cardiac rehabilitation]] programs should include discussion of sexual activity in an open, frank and sensitive manner.
*Randomized, controlled secondary prevention trials like the Heart and Estrogen / Progestin Replacement Study (HERS), HERS-II and the Women’s Health Initiative (WHI) have suggested that [[hormone replacement therapy]] does not reduce cardiovascular events or mortality in patients with [[stable angina|stable angina pectoris]]. Therefore current recommendations and practice guidelines do not support the use of [[hormone replacement therapy]] to reduce the risk of heart disease.
 
===Monitoring outcomes and follow up as needed===
 
==Sexual Activity==
 
*Common sexual problems encountered by cardiac patients include impotence and premature or delayed ejaculation in men and reduced libido in both men and women.
 
These difficulties may be due to underlying disease ([[Atherosclerosis|systemic atherosclerosis]], [[Peripheral Vascular Disease|peripheral arterial disease]], [[diabetes mellitus]], medications (e.g, [[statins]], [[beta blockers]], [[diuretics]]), depression, and fear in both the patient and his or her partner of precipitating a cardiac event.
 
*Maximum heart rate during sexual intercourse averages 120 bpm, which is similar to heart rates associated with other routine activities in and around the house. There for patients with cardiovascular disorders should not have any restrictions under normal conditions and controlled medications.
*Patients should be informed about the possible hemodynamic response with an unfamiliar partner or surroundings and after eating or consuming alcohol (it is greater than normal conditions).
*Adapting less strenuous positions, such as side-to-side rather than missionary positions, can reduce cardiac stress.
*Patients may start sexual activity 2-3 weeks following an uncomplicated acute myocardial infarction. They must be instructed to report any untoward symptoms to the physician or member of the rehabilitation team.<ref>Singh VN Cardiac Rehabilitation http://www.emedicine.com/pmr/topic180.htm. Access date:27.01.2008 </ref><ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
 
==Contraindications of Cardiac Rehabilitation==
 
*Poorly controlled [[hypertension]]
*Uncompensated [[heart failure]]
*Uncontrolled [[arrhythmias|severe arrhythmias]]
*Severe residual, treatment resistant [[angina pectoris|angina]]
*Severe cardiac ischemia, advanced left ventricular dysfunction, or frequent [[arrhythmias]] during exercise testing
*Exaggerated exercise reactions as hypertensive or any hypotensive systolic blood pressure response to exercise
*Unstable concomitant medical problems (e.g, poorly controlled or "brittle" [[diabetes mellitus]], diabetes prone to [[hypoglycemia]], ongoing febrile illness, active transplant rejection) <ref>Singh VN Cardiac Rehabilitation http://www.emedicine.com/pmr/topic180.htm. Access date:27.01.2008 </ref>


==Sources==
==Sources==
Line 235: Line 44:
*The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078|doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
*The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078|doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>


==References==
*The AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. <ref name="pmid17885210">{{cite journal |author=Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J |title=AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services |journal=Circulation |volume=116 |issue=14 |pages=1611–42 |year=2007 |month=October |pmid=17885210 |doi=10.1161/CIRCULATIONAHA.107.185734 |url=}}</ref>
{{Reflist|2}}


==Additional Resources==
*2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction<ref name="pmid23247303">{{cite journal |author=O'Gara PT, Kushner FG, Ascheim DD, ''et al.'' |title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=Circulation |volume= |issue=|pages=|year=2012 |month=December |pmid=23247303 |doi=10.1161/CIR.0b013e3182742c84|url=}}</ref>
*[http://www.americanheart.org/presenter.jhtml?identifier=3047638  American Heart Association]
*[http://www.clinicaltrialresults.org  Clinical Trial Results: An Up-to-Date Resource of Cardiovascular Research]
*[http://www.guideline.gov  National Guidelines Clearinghouse]
*[http://www.nlm.nih.gov  National Library of Medicine at National Institute of Health]
*[http://www.themdtv.org The MD TV: A Comprehensive Audio Visual Resource of Cardiovascular Science]


==Cardiac Rehabilitation Centers==
==Cardiac Rehabilitation Centers==
 
'''In Alphabetical Order'''
'''In alphabetical order'''
 
*[http://www.bidmc.harvard.edu/display.asp?node_id=8565  Beth Israel Deaconess Medical Center]
*[http://www.bidmc.harvard.edu/display.asp?node_id=8565  Beth Israel Deaconess Medical Center]
*[http://healthlibrary.brighamandwomens.org/library/AdultLibrary/Cardiovascular/85,P00202 Brigham & Women's Hospital Cardiovascular Rehabilitation Center]
*[http://healthlibrary.brighamandwomens.org/library/AdultLibrary/Cardiovascular/85,P00202 Brigham & Women's Hospital Cardiovascular Rehabilitation Center]
Line 259: Line 60:
*[http://ymghealthinfo.org/content.asp?pageid=P00202  Yale University School of Medicine Cardiac Rehabilitation Center]
*[http://ymghealthinfo.org/content.asp?pageid=P00202  Yale University School of Medicine Cardiac Rehabilitation Center]


==References==
{{Reflist|2}}


{{Circulatory system pathology}}
[[Category:Disease]]
{{SIB}}
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Ischemic heart diseases]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]
[[Category:Mature chapter]]


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Latest revision as of 16:43, 28 January 2013

Acute Coronary Syndrome Main Page

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT) [1][2]

Class I
"1. Cardiac rehabilitation/secondary prevention programs, when available, are recommended for patients with STEMI, particularly those with multiple modifiable risk factors and/or those moderate- to high-risk patients in whom supervised exercise training is warranted. (Level of Evidence: B)"
"2. For all patients, it is recommended that risk be assessed with a physical activity history and/or an exercise test to guide prescription. (Level of Evidence: B)"
"3. For all patients, encouraging 30 to 60 minutes of moderate-intensity aerobic activity is recommended, such as brisk walking on most preferably all days of the week, supplemented by an increase in daily lifestyle activities (e.g., walking breaks at work, gardening, and household work). (Level of Evidence: B)"
Class IIb
"1. Encouraging resistance training 2 days per week may be reasonable. (Level of Evidence: C)"

2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)[3]

Posthospitalization Plan of Care (DO NOT EDIT)[3]

Class I
"1. Posthospital systems of care designed to prevent hospital readmissions should be used to facilitate the transition to effective, coordinated outpatient care for all patients with STEMI.[4][5][6][7][8](Level of Evidence: B)"
"2. Exercise-based cardiac rehabilitation/secondary prevention programs are recommended for patients with STEMI.[9][10][11][12](Level of Evidence: B)"
"3. A clear, detailed, and evidence-based plan of care that promotes medication adherence, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with interventions for secondary prevention should be provided to patients with STEMI.(Level of Evidence: C)"
"4. Encouragement and advice to stop smoking and to avoid secondhand smoke should be provided to patients with STEMI.[13][14][15][16](Level of Evidence: A)"

Sources

  • The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [17]
  • The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [2]
  • The AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. [18]
  • 2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction[3]

Cardiac Rehabilitation Centers

In Alphabetical Order

References

  1. ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388.
  2. ↑ 2.0 2.1 Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 3.2 O'Gara PT, Kushner FG, Ascheim DD; et al. (2012). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e3182742c84. PMID 23247303. Unknown parameter |month= ignored (help)
  4. ↑ Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M (1994). "Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial". Ann. Intern. Med. 120 (12): 999–1006. PMID 8185149. Unknown parameter |month= ignored (help)
  5. ↑ Coleman EA, Parry C, Chalmers S, Min SJ (2006). "The care transitions intervention: results of a randomized controlled trial". Arch. Intern. Med. 166 (17): 1822–8. doi:10.1001/archinte.166.17.1822. PMID 17000937. Unknown parameter |month= ignored (help)
  6. ↑ Young W, Rewa G, Goodman SG; et al. (2003). "Evaluation of a community-based inner-city disease management program for postmyocardial infarction patients: a randomized controlled trial". CMAJ. 169 (9): 905–10. PMC 219623. PMID 14581307. Unknown parameter |month= ignored (help)
  7. ↑ Jack BW, Chetty VK, Anthony D; et al. (2009). "A reengineered hospital discharge program to decrease rehospitalization: a randomized trial". Ann. Intern. Med. 150 (3): 178–87. PMC 2738592. PMID 19189907. Unknown parameter |month= ignored (help)
  8. ↑ Lappé JM, Muhlestein JB, Lappé DL; et al. (2004). "Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program". Ann. Intern. Med. 141 (6): 446–53. PMID 15381518. Unknown parameter |month= ignored (help)
  9. ↑ Leon AS, Franklin BA, Costa F; et al. (2005). "Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation". Circulation. 111 (3): 369–76. doi:10.1161/01.CIR.0000151788.08740.5C. PMID 15668354. Unknown parameter |month= ignored (help)
  10. ↑ Suaya JA, Stason WB, Ades PA, Normand SL, Shepard DS (2009). "Cardiac rehabilitation and survival in older coronary patients". J. Am. Coll. Cardiol. 54 (1): 25–33. doi:10.1016/j.jacc.2009.01.078. PMID 19555836. Unknown parameter |month= ignored (help)
  11. ↑ Taylor RS, Brown A, Ebrahim S; et al. (2004). "Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials". Am. J. Med. 116 (10): 682–92. doi:10.1016/j.amjmed.2004.01.009. PMID 15121495. Unknown parameter |month= ignored (help)
  12. ↑ Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ (2011). "Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community". Circulation. 123 (21): 2344–52. doi:10.1161/CIRCULATIONAHA.110.983536. PMID 21576654. Unknown parameter |month= ignored (help)
  13. ↑ Wilson K, Gibson N, Willan A, Cook D (2000). "Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies". Arch. Intern. Med. 160 (7): 939–44. PMID 10761958. Unknown parameter |month= ignored (help)
  14. ↑ Thomson CC, Rigotti NA (2003). "Hospital- and clinic-based smoking cessation interventions for smokers with cardiovascular disease". Prog Cardiovasc Dis. 45 (6): 459–79. doi:10.1053/pcad.2003.YPCAD15. PMID 12800128.
  15. ↑ Dawood N, Vaccarino V, Reid KJ, Spertus JA, Hamid N, Parashar S (2008). "Predictors of smoking cessation after a myocardial infarction: the role of institutional smoking cessation programs in improving success". Arch. Intern. Med. 168 (18): 1961–7. doi:10.1001/archinte.168.18.1961. PMID 18852396. Unknown parameter |month= ignored (help)
  16. ↑ Shah AM, Pfeffer MA, Hartley LH; et al. (2010). "Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalization associated with smoking status following myocardial infarction with left ventricular dysfunction". Am. J. Cardiol. 106 (7): 911–6. doi:10.1016/j.amjcard.2010.05.021. PMID 20854949. Unknown parameter |month= ignored (help)
  17. ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter |month= ignored (help)
  18. ↑ Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J (2007). "AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services". Circulation. 116 (14): 1611–42. doi:10.1161/CIRCULATIONAHA.107.185734. PMID 17885210. Unknown parameter |month= ignored (help)


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