The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

heart rate variability, micro T-wave alternans, and
T-wave variability) in patients recovering from
STEMI. (Level of Evidence: B)

K. Secondary prevention
See Figures 3.9, 3.10.

Class I
Patients who survive the acute phase of STEMI
should have plans initiated for secondary prevention
therapies. (Level of Evidence: A)

1. Patient education before discharge
   Class I
   1 Before hospital discharge, all STEMI patients
   should be educated about and actively involved in
   planning for adherence to the lifestyle changes and
   drug therapies that are important for the secondary
   prevention of cardiovascular disease. (Level of Evi-
   dence: B)
   2 Post-STEMI patients and their family members
   should receive discharge instructions about recog-
   nizing acute cardiac symptoms and appropriate
   actions to take in response (i.e., calling 9-1-1 if
   symptoms are unimproved or worsening 5 minutes
   after onset, or if symptoms are unimproved or wors-
   ening 5 minutes after one sublingual nitroglycerin

dose) to ensure early evaluation and treatment

should symptoms recur. (Level of Evidence: C)

3 Family members of STEMI patients should be

advised to learn about AEDs and CPR and be

referred to a CPR training program. Ideally, such

training programs would have a social support com-

ponent targeting family members of high-risk

patients. (Level of Evidence: C)

Contemporary recommendations for secondary

prevention after STEMI can be found in the

updated material contained in Chapter 5.

2. Antiplatelet therapy
   See Figure 3.11.

Class I

1 A daily dose of aspirin 75 to 162 mg orally should

be given indefi nitely to patients recovering from

STEMI. (Level of Evidence: A)

2 If true aspirin allergy is present, preferably clopi-

dogrel (75 mg orally per day) or, alternatively,

ticlopidine (250 mg orally twice daily) should be

substituted. (Level of Evidence: C)

3 If true aspirin allergy is present, warfarin therapy

with a target INR of 2.5 to 3.5 is a useful alternative

to clopidogrel in patients less than 75 years of age

Fig. 3.9 Recommendations for secondary prevention after STEMI: smoking cessation, BP control, physical activity.