You’ve survived a heart attack. What do you do now?

If you’ve survived a heart attack, the first thing you might do is count your blessings. After that? It’s time to choose whether you’re going to make some changes for the better or go back to what you were doing before.

“It’s the smaller number of patients who really alter their lifestyle and take the opportunity to make changes that are going to be both lasting and impact their subsequent outcomes in both quality of life and eventual survival from cardiac disease,” said Karl Stajduhar, MD, FACC, a cardiology hospitalist at Cape Cod Hospital.

Not long after emergency care has stabilized a patient, a cardiologist will assess the extent of damage that the heart attack may have caused, its specific cause and the risk of subsequent events.

“This evaluation includes blood work and imaging studies, such as echocardiogram, stress test, and cardiac catheterization,” said Dr. Stajduhar. Those studies may be done in the hospital or as an outpatient soon after the patient’s release.

“We look to institute what is termed guideline-directed medical therapy,” he said. “That is therapy that has been demonstrated to be of high-quality value and has been vetted by the American Heart Association and the American College of Cardiology. These are the medications or therapies that reduce subsequent events, improve quality of life, and improve long-term survival.”

Before Leaving the Hospital

Education is an important part of a hospital stay, according to Dr. Stajduhar.

“Prior to leaving the hospital, the patient should have a clear recommendation of what activities they’re able to do, and then a plan for increasing activity,” he said. A physical therapist or occupational therapist can help determine what a patient is able to do over the short and long term as an outpatient.

Another component of education is risk factor modification, which may include addressing diabetes, high cholesterol, hypertension and obesity, as well as tobacco and excess alcohol use. Sleep issues also can affect cardiac health, he said.

Patients should leave the hospital with an updated list of medications.

“Ideally, when the patient goes to see their primary care provider or their cardiologist, not only do they take that list, they take the actual medicines that they have been taking. This allows the provider to reconcile the medications with the list,” he said. “The provider should then provide a clear, updated list of the patient’s medications that are appropriate for their cardiac condition and other issues they might have.” That includes over-the-counter drugs and supplements, because they can impact the outcomes for a person with cardiac disease, he added.

Patients should receive nutrition advice from a dietitian before going home. “It’s helpful to have family members present, especially the person who’s doing the cooking,” said Dr. Stajduhar.

Patients should have instructions about when they can resume activity, when to call the doctor, when to call 911, and how to respond to symptoms that might suggest recurrent cardiac issues, such as chest pain, shortness of breath, palpitations or lightheadedness or fainting, he said.

After Leaving the Hospital

If cardiac rehab is prescribed, Dr. Stajduhar recommends making it a priority, since some studies suggest that rehab may result in a 25 percent reduction in mortality. “This is the point where people really need to think, ‘I need to attend to my health as my first priority and avail myself of every opportunity.’ Cardiac rehab provides a wonderful level of support in terms of other people who ‘have been there.’ Cardiac rehab attends to non-exercise-related education, as well, such as counseling for diet, counseling for mental health, for sleep hygiene,” he said.

People with established cardiac disease are at much higher risk for bad outcomes from the flu, pneumonia, COVID-19, so be sure your vaccinations are up to date.

Be sure to establish a healthcare proxy, he said. “It may be morbid to think about, but if you’re not able to participate in decision making, you want to have a proxy answer for you the same as you would want your medical care to be done,” he said.

Whatever goals you set, take things in small steps, he said. “Mark each one as a success and then build on that. Smaller steps to reach one’s goals are a more sustainable way to do things, rather than wondering, how am I going to do this all at once?”