ÎÎPostmenopausal women who are already taking estrogen plus
progestin, or estrogen alone, at the time of UA/NSTEMI in general
should NOT continue hormone therapy. However, women who are
more than 1-2 years past the initiation of hormone therapy who wish to
continue such therapy for another compelling indication should weigh
the risks and benefits, recognizing the greater risk of cardiovascular
events and breast cancer (combination therapy) or stroke (estrogen).
Hormone therapy should not be continued while patients are on
bedrest in the hospital. (III-B)
Antioxidant Vitamins and Folic Acid
ÎÎAntioxidant vitamin supplements (eg, vitamins E, C, or beta carotene)
should NOT be used for secondary prevention in UA/NSTEMI patients.
(III-A)
ÎÎFolic acid, with or without B6 and B12, should NOT be used for
secondary prevention in UA/NSTEMI patients. (III-A)
Postdischarge Follow-Up
ÎÎDetailed discharge instructions for post-UA/NSTEMI patients
should include education on medications, diet, exercise, and
smoking cessation counseling (if appropriate), referral to a cardiac
rehabilitation/secondary prevention program (when appropriate), and
the scheduling of a timely follow-up appointment. Low-risk medically
treated patients and revascularized patients should return in 2-6
weeks, and higher-risk patients should return within 14 days. (I-C)
ÎÎPatients with UA/NSTEMI managed initially with a conservative
strategy who experience recurrent signs or symptoms of UA or severe
(CCS class III) chronic stable angina despite medical management
who are suitable for revascularization should undergo timely coronary
angiography. (I-B)
ÎÎPatients with UA/NSTEMI who have tolerable stable angina or no
anginal symptoms at follow-up visits should be managed with longterm medical therapy for stable CAD. (I-B)
ÎÎCare should be taken to establish effective communication between
the post-UA/NSTEMI patient and health care team members to
enhance long-term compliance with prescribed therapies and
recommended lifestyle changes. (I-B)
Cardiac Rehabilitation
ÎÎPrescribe cardiac rehabilitation/secondary prevention programs,
when available, for patients with UA/NSTEMI, particularly those
with multiple modifiable risk factors and those moderate- to highrisk patients in whom supervised or monitored exercise training is
warranted. (I-B)
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