A.M.I. (Acute Myocardial Infarct) Program

Over the past decade, due to advances in medical therapy and the widespread use of thrombolytic therapy, the Acute Myocardial Infarct (AMI) patient suffers fewer complications associated with the Myocardial Infarct (MI). There is a trend indicating that patients who mobilize sooner and assume responsibilites for self care earlier, are discharged from the hospital sooner than those who do not.  Although increases in physical activity progress rapidly, the structure/in-hospital cardiac teaching program cannot be successfully completed during a shortened hospital stay. The program includes a nurse home visit and follow-up teaching for acute myocardial infarction patients who are sent home from hospital.

The target group includes all patients admitted to Concordia Hospital with a diagnosis of AMI. The overall purpose is to decrease the length of stay in hospital and enhance the delivery of cardiac teaching to the patient and family.

The program makes it possible for the cardiac teaching to be initiated in the hospital and be continued post discharge through one individual home visit and one group class session.

The program has demonstrated that cardiac teaching done in a more timely format leads to behavioural change and risk modification and therefore improves the quality of care in addition to a shorter hospital stay.

Objectives of the Program

• Provide a support link for patients and families in the immediate post-discharge period (first six weeks or phase II of recovery)
• Provide a more timely delivery of cardiac teaching that may lead to actual behaviour change and risk modification in the AMI patient and family.
• Decrease length of stay in hospital.
• Decrease the number of patients requiring readmission for cardiac related complaints.

Target Group
The following inclusion criteria is used as a guideline to ensure support services are not duplicated after discharge and the program is offered to those patients who would gain the most benefit.

Candidates must:

• be cognisant
• be able to speak and read English
• be able to mobilize cardiovascular improvement
• be independent of alternate support services in the home after discharge. The program is voluntary and the patients' written consent is obtained.

Patients who are not considered appropriate candidates receive in hospital instructions as outlined in the cardiac teaching guide accompanied with the "Heart Attack" booklet.

Intervention
Once the patient meets the inclusion criteria and the patient's consent is obtained, they are enrolled in the program.

While in hospital, the post AMI patient receives education/instruction related to immediate recovery needs given by the hospital nurse. The visiting nurse continues the teaching post discharge.

The visiting nurse visits the patient in hospital to set up future appointments. The home nurse visit occurs seven to ten days after discharge. The patient and family attends an evening class at Concordia approximately one month after discharge.

During the home visit and evening class, patients and families receive more detailed information on:

• cardiovascular health
• diet
• exercise
• medication review
• reaffirmation of doctor appointments

Following discharge, a 24 hour "heart talk" phone line at Concordia allows phone support for patients/families seeking information, clarification or reassurance.

Staff Qualifications
An Intensive Care Registered Nurse certified as an Exercise Specialist conducts the home visits and monthly education class. She has extensive experience in cardiac rehabilitation.

Evaluation
The Nurse Home Visit Program is well received by patients and their families. Patients often save questions for the visit and have a list drawn up for the nurse to answer. Medications are reviewed, doctor's appointments reaffirmed, and diet/activity reinforced.

A telephone evaluation is conducted 2 months after hospital discharge and results to date are very positive indicating lifestyle changes in process.

The Nurse Home Visit Program for AMI has continued to be very successful in achieving the following outcomes:

• hospital length of stay is reduced significantly
• provides a community support link for AMI patients/families in the immediate post discharge period. The program gives the patients reassurance and support making the transition from hospital to home easier and less fearful.
• cardiac teaching is delivered in a more timely fashion
• the number of patients returning to emergency for cardiac related complaints has decreased

The continuation of this program is felt to be a progressive step in keeping with health reform.

All re-admissions within one month of discharge have been reviewed. The results demonstrate a reduction by 2.7% of re-visits/readmission rates for cardiac related events.