Late Hospital Care, Hospital Discharge, and Post-Hospital
Discharge Care
Medical Regimen and Use of Medications
ÎÎMedications required in the hospital to control ischemia should be
continued after hospital discharge in patients with UA/NSTEMI who
do not undergo coronary revascularization, patients with unsuccessful
revascularization, and patients with recurrent symptoms after
revascularization. Upward or downward titration of the doses may be
required. (I-C)
ÎÎAll post-UA/NSTEMI patients should be given sublingual or spray NTG
and instructed in its use. (I-C)
ÎÎBefore hospital discharge, patients with UA/NSTEMI should be
informed about symptoms of worsening myocardial ischemia and MI
and should be instructed in how and when to seek emergency care and
assistance if such symptoms occur. (I-C)
ÎÎBefore hospital discharge, post-UA/NSTEMI patients and/or
designated responsible caregivers should be provided with
supportable, easily understood, and culturally sensitive instructions
with respect to medication type, purpose, dose, frequency, and
pertinent side effects. (I-C)
ÎÎIn post-UA/NSTEMI patients, anginal discomfort lasting more than 2-3
min should prompt discontinuation of physical activity or removal from
any stressful event. If pain does not subside immediately, the patient
should be instructed to take one dose of NTG sublingually. If the chest
discomfort/pain is unimproved or worsening 5 min after one NTG
dose has been taken, it is recommended that the patient or a family
member/friend call 9-1-1 immediately to access EMS. While activating
EMS access, additional NTG (at 5-min intervals 2 times) may be taken
while lying down or sitting. (I-C)
ÎÎIf the pattern or severity of anginal symptoms changes, which
suggests worsening myocardial ischemia (eg, pain is more frequent
or severe or is precipitated by less effort or now occurs at rest), the
patient should contact his or her physician without delay to assess the
need for additional treatment or testing. (I-C)
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