Treatment
22
Table 16. Late Hospital Care, Hospital Discharge, and
Posthospital Discharge Care (cont'd)
Recommendations
COR LOE
Risk reduction strategies for secondary prevention
All eligible patients with NSTE-ACS should be referred to a
comprehensive cardiovascular rehabilitation program either before
hospital discharge or during the first outpatient visit.
I B
e pneumococcal vaccine is recommended for patients ≥65 years
of age and in high-risk patients with cardiovascular disease.
I B
Patients should be educated about appropriate cholesterol
management, BP, smoking cessation, and lifestyle management.
I C
Patients who have undergone PCI or CABG derive benefit
from risk factor modification and should receive counseling that
revascularization does not obviate the need for lifestyle changes.
I C
Before hospital discharge, the patient's need for treatment of
chronic musculoskeletal discomfort should be assessed, and a
stepped-care approach should be used for selection of treatments.
Pain treatment before consideration of NSAIDs should begin with
acetaminophen, nonacetylated salicylates, tramadol, or small doses
of narcotics if these medications are not adequate.
I C
It is reasonable to use nonselective NSAIDs, such as naproxen,
if initial therapy with acetaminophen, nonacetylated salicylates,
tramadol, or small doses of narcotics is insufficient.
IIa C
NSAIDs with increasing degrees of relative cyclooxygenase-2
selectivity may be considered for pain relief only for situations in
which intolerable discomfort persists despite attempts at stepped-
care therapy with acetaminophen, nonacetylated salicylates,
tramadol, small doses of narcotics, or nonselective NSAIDs. In all
cases, use of the lowest effective doses for the shortest possible time
is encouraged.
IIb C
Antioxidant vitamin supplements (e.g., vitamins E, C, or beta
carotene) should NOT be used for secondary prevention in patients
with NSTE-ACS.
III: No
Benefit
A
Folic acid, with or without vitamins B
6
and B
12
, should NOT be
used for secondary prevention in patients with NSTE-ACS.
III: No
Benefit
A
Hormone therapy with estrogen plus progestin, or estrogen alone,
should NOT be given as new drugs for secondary prevention of
coronary events to postmenopausal women aer NSTE-ACS and
should NOT be continued in previous users unless the benefits
outweigh the estimated risks.
III:
Harm
A
NSAIDs with increasing degrees of relative cyclooxygenase-2
selectivity should NOT be administered to patients with NSTE-
ACS and chronic musculoskeletal discomfort when therapy with
acetaminophen, nonacetylated salicylates, tramadol, small doses of
narcotics, or nonselective NSAIDs provide acceptable pain relief.
III:
Harm
B
