Last updated: Apr 24, 2008
Next comes recovery, a process that can last weeks, months, or the rest of your life. The risk of death or cardiac arrest is highest during the first 30 days of recovery after a heart attack.
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Patients who were relatively young and healthy before their attack tend to regain strength more quickly than others. People who had minor heart attacks are also likely to fare well in the long term, especially with prompt treatment. In contrast, patients who lose large chunks of heart muscle may never regain anything close to their previous health.
Being obese is a major risk factor for death after heart attack. In a study of nearly 2,000 patients recovering from a heart attack, obese patients were nearly 50% more likely to die within four years. And for people who were already chronically ill with diabetes, cancer, or another serious illness, a heart attack can be a devastating blow that leaves them permanently disabled.
Quality of care and follow-up
The quality of medical care during recovery has a huge impact on a person's long-term prospects, says Sharonne Hayes, MD, director of the Mayo Clinic's Women's Heart Clinic.
"Patients who go home with aspirin, a statin, and a beta-blocker do better than those who don't," says Dr. Hayes. "In 25% of cases doctors neglect to prescribe these despite clear evidence of their effectiveness."
Another key factor is a patient's use of cardiac rehabilitation, a supervised program that uses exercise, education about healthy living, and support to help people recover from a heart attack.
These programs are medically supervised, measurably increase quality of life, reduce mortality rates for heart patients, and are usually covered by insurance. Yet the American Heart Association estimates that only between 10% and 20% of eligible patients participate. "Everyone who has had a recent heart attack or a coronary surgery should be considered a candidate for cardiac rehab," says Brandeis University's Jose Suaya, MD, the lead author of a recent study that found that just 14% of elderly heart attack survivors on Medicare participated in rehab.
Research suggests that the likelihood of a patient adopting a healthier lifestyle after a heart attack is related to socioeconomic status. A University of Toronto study of more than 3,500 patients found that, one month after a heart attack, those with the highest incomes were significantly less likely to smoke and drink and more likely to exercise, compared with those with the lowest incomes. Patients who exercised more had a significantly lower mortality rate over two years.
Emotional recovery takes longer
Even when a survivor quickly recovers physically, emotional recovery may be elusive.Kevin Ambrose, 52, of Washington Grove, Md., says that post-heart-attack, he initially avoided certain outings, like golf, because "I was afraid to be too far from an emergency room."
Deb Kautz, 46, of Zumbro Falls, Minn., felt revitalized after treatment for a minor heart attack. But once home, "I was a wreck," she says. "I was scared it was going to happen again, and I had nothing to do but sit around and think about it."
Within two weeks Kautz was taking cardiac rehabilitation classes at the Mayo Clinic and feeling better. The combination of exercise, diet counseling, and support from staff and other patients gave her new confidence that she would be able to beat her heart disease.
Two months after her program, "I feel great," Kautz says. "I got a second chance." She asks her doctor lots of questions, but there's one they can't answer: "What are the chances of my arteries clogging up again and my having another heart attack? They just don't know. I guess I'll live with that question the rest of my life, but I'm taking the steps to make sure it doesn't happen again."