Acute Myocardial Infarction (Heart Attack)

Each year, more than a million Americans have an acute myocardial infarction – a heart attack. A heart attack is an injury to the heart muscle resulting from a loss of blood supply. It usually occurs when a clot blocks the flow of blood through an artery that supplies blood to the heart itself. A heart attack can damage part of the heart, leading to congestive heart failure. However, appropriate treatment of a patient with symptoms of a heart attack can prevent or lessen damage.

Aspirin at arrival – For patients having or suspected of having a heart attack, early treatment with aspirin can significantly reduce the amount of damage or the chance of dying.

Aspirin at discharge – Long-term use of aspirin after a heart attack can significantly reduce the change of another heart attack, stroke, or death.

Beta-blocker medication at arrival – Beta-blocker medications can relieve high blood pressure, relieve chest pain and help prevent additional heart attacks. Beta-blocker medications given to patients during the initial hours of a heart attack can lessen the severity of the heart attack and reduce the risk of future heart attacks.

Beta-blocker medication prescribed at discharge – Beta-blocker medications are used to treat high blood pressure, may be used to relieve chest pain and can help prevent additional heart attacks. For those who have had a heart attack, beta-blocker medications are associated with a lower risk of long-term heart disease and death.

ACE inhibitor medication for left ventricular systolic dysfunction (LVSD) – Left ventricular systolic dysfunction (LVSD) occurs when the left ventricle, or chamber of the heart, pumps less blood than it should. If a patient has a heart attack because his or her left ventricle is not working properly, angiotensin-converting enzyme inhibitors, or ACE inhibitor medications make it easier for the heart to pump.

Smoking Cessation Counseling -- Smoking contributes to complications associated with a heart attack. Patients that are given advice on how to quit smoking by their health care provider during a hospitalization are more likely to stop smoking. Quitting smoking while in the hospital can also help the patient's recovery from a heart attack.

Congestive heart failure is a disorder in which the heart loses its ability to pump blood efficiently. Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.

Left ventricular function assessment – Assessing the left ventricular function (LVF) of the heart helps evaluate the heart's ability to work efficiently. Without testing the function of the heart, a patient may not receive the care he or she needs to obtain the best function possible.

ACE inhibitor medication for left ventricular systolic dysfunction (LVSD) - Left ventricular systolic dysfunction (LVSD) occurs when the left ventricle, or chamber of the heart pumps less blood than it should. If a patient has a heart attack because his or her left ventricle is not working properly, angiotensin-converting enzyme inhibitors, or ACE inhibitor medications make it easier for the heart to pump.

Smoking Cessation Counseling – Smoking contributes to complications associated with congestive heart failure. Patients that are given advice on how to quit smoking by their health care provider during a hospitalization are more likely to stop smoking. Quitting smoking while in the hospital can also help the patient's recovery.

Discharge Instructions – Educating patients with heart failure and their families is critical to the successful home management of congestive heart failure. Patients who do not understand and follow instructions from their health care providers are often re-hospitalized. Patients and their families should understand how to take prescribed medications, monitor their weight, exercise regularly and follow a healthy diet. In addition, patients should be seen by their health care provider for a follow-up appointment after they are hospitalized and know what to do if symptoms worsen.

Pneumonia is a condition caused by a bacterial infection of the respiratory system. Although not all patients that have pneumonia are admitted to the hospital, those with more severe cases or those who have a weakened immune system, may require hospitalization so that they can receive antibiotics and other treatments more quickly.

First Antibiotic within 4 hours – There is growing evidence of an association between timely administration of antibiotics and improved survival for patients admitted with pneumonia. Although the "best" minimal time has not been established, several studies support the time-to-first-antibiotic to be 4 hours. In 2000, the Infectious Diseases Society of America suggested 8 hours as the maximum time to first antibiotic.

Oxygen assessment – Inadequate oxygen in the blood is a common effect of pneumonia and is known to increase the chance of dying. Pneumonia patients should have their oxygen level checked within 24 hours of coming to the hospital. If the oxygen level is low, supplemental oxygen can be given to reduce the chance of dying.

Pneumococcal screening and/or vaccination – Pneumococcal vaccination is indicated for person age 65 and older because it is up to 75% effective in preventing pneumococcal bacteremia (bacteria in the blood) and meningitis (inflammation of the lining of the brain and spinal cord). It is also an important vaccine due to an increase in bacteria that are resistant to antibiotics. Patients that are admitted to the hospital with pneumonia should be asked if they have received a pneumococcal vaccine. If they have not received the vaccine, it should be given to the patient before they leave the hospital.

Smoking Cessation Counseling – Smoking cessation is essential for patients with pneumonia. Patients that are given advice on how to quit smoking by their health care provider during a hospitalization are more likely to quit smoking. Quitting smoking while in the hospital can also help the patient's recovery from pneumonia.