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UA/NSTEMI (ACC)

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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) 41

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