ACS-24 Education: Module highlight - Risk Factors
Having a heart attack is a major life event, and patient education is an important part of a patient’s care. Engaging in conversation about cardiac risk factors following an ACS event allows patients to decide and focus on lifestyle changes that impact on their own personal overall heart health.
A shared decision model outlined by the American College of Cardiology and the American Heart Association is one of many tools to assist clinicians in engaging in authentic conversations about risk factor modification. The September’s 2022 ACS Network’s newsletter also reviews the key concepts of motivational interviewing to assist in this conversation. Involve significant others in communication where appropriate.
Risk factors increase a person’s risk of a heart attack. Some risk factors can be changed, while some cannot be changed. The Living Well With Heart Disease Book (Heart and Stroke) Chapter 1 provides a comprehensive review of cardiac risk factors and is a great resource to begin the conversation. Links to all resources are located at the end of this publication. Teaching points in our Patient ACS Network Education module:
Lifestyle Risk Factors:
Importance of being smoke-free: Reinforce that this is one of the most important things a person can do for their heart. There is no safe amount of smoking, even second-hand smoke. Any amount of smoking increases the risk of a heart attack.
Exercise: Exercise is good medicine for the heart. It helps lower blood pressure, improve cholesterol, control weight, and make one feel better. Encourage patients to follow the recommendations provided in the hospital.
Eating a heart-healthy diet: Heart-healthy eating can improve cholesterol levels, lower blood pressure, and maintain good blood sugar levels.
Body weight: Exercise and heart-healthy eating assist in maintaining a healthy weight. Provide information about the range their weight should be at and assist in goal setting.
Stress: Coping with stress is good for one’s heart. Patients need to understand their stress, how to manage it, and how to care for themselves. There are many ways to help with stress, such as balancing work and personal life, exercising regularly, eating well, practicing meditation, yoga, and paying attention to sleep.
Alcohol and Recreational Drugs: Alcohol is a risk factor for high blood pressure and weight gain. There is no safe level of alcohol. Any recreational drug can increase the risk of having a stroke or heart attack.
Non-Modifiable Risk Factors:
Age and Sex: The risk of a heart attack increases with age. Heart attacks in women increase after menopause. The Canadian Women’s Heart Health Alliance is a good resource to learn more about risk factors specifically in women.
Family History: A patient is at higher risk of heart disease if their mother or a sister had a heart attack before 65, before menopause, or their father or brother had a heart attack before age 55.
Ethnicity: Indigenous, South Asian, Polynesians, Filipinos, and African populations are at a higher risk of heart disease. This is because these ethnic groups often have elevated rates of high blood pressure, increased amounts of visceral and liver fat, and a higher prevalence of diabetes.
Medical Conditions:
High Blood Pressure: Increases the work of the heart and is an important risk factor for heart attack. Ensure the patient knows their blood pressure numbers and if it is within normal range.
Cholesterol: Patients will typically be prescribed a 'statin' to reduce cholesterol. While diet is helpful, it alone cannot achieve the necessary cholesterol reductions. Adherence to medication is crucial.
Diabetes: People with diabetes are at an increased risk of heart complications due to elevated blood sugar levels that can harm blood vessels and nerves. Medications help manage these levels and address other risk factors like high blood pressure or cholesterol. Therefore, for those with diabetes, medication is essential to prevent further heart attacks.
Resources that might be helpful:
Living Well with Heart Disease Book
https://www.heartandstroke.ca/-/media/c404134260fe4c81b5aa4a4a861803ee.ashx
Resource assistance for all Manitobans 18+ who want to quit smoking https://sharedhealthmb.ca/patient-care/quit-smoking/
Shared Decision Model ACC/AHA: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045897/
Canadian Women’s Heart Health Alliance: https://cwhhc.ottawaheart.ca/education/risk-factors/gender
MB ACS Network Cardiac Risk Factor Module: https://static1.squarespace.com/static/61ec8b297e07f10c54082ef8/t/63e30f3a06e7cd32523867bd/1675824954396/ACS-EN+Risk+Factors.pdf
