Wishing You a Speedy Recovery

Feeling rushed these days? It’s hard not to. Signs of a faster pace of life seem to be all around us, even in the hospital. Seemingly short hospital stays are now the rule for conditions ranging from heart attack and stroke to radical prostate removal and hip replacement. After a heart attack, for example, some people are now being sent home after 72 hours.

Isn’t three days awfully fast? It depends on your point of view. From the perspective of insurers and hospitals, it’s just about right for people with straightforward and uncomplicated attacks. But from the perspective of someone who has just survived such a life-changing event, three days probably doesn’t seem like nearly enough time to cope with what’s happened and learn how to handle the next phase of your life.

How long to have someone stay in the hospital after a heart attack is based more on precedent than solid evidence. "It’s a difficult balancing act," says Dr. David A. Morrow, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital. "Doctors have to consider the size and severity of the attack, complications, and the patient’s general health, and at the same time be aware of the cost of hospital care."

Shrinking stays

Before the mid-1950s, heart attack survivors spent a long time bedridden in the hospital and rarely returned to work or normal activity.

President Dwight Eisenhower helped change that — not by law or executive fiat, but by how he and his doctors handled his heart attack (see Ike’s heart attack below). In the late 1950s, the average hospital stay following a heart attack was about 50 days. Now it hovers around five days. Current guidelines from the American Heart Association recommend four days in the hospital following an uncomplicated heart attack, and discharges after three days are becoming routine.

Much of this decline is due to advances in drug therapy, technology, surgery, pain control, and general hospital care. Some is due to economics.

Defining safe stays

Short stays have some scientific basis, though not much. A handful of small studies show that people with relatively simple heart attacks who are at low risk for complications can safely leave the hospital after three or four days. "Safely" here means they are no more likely to develop a heart rhythm problem, heart failure, or another heart attack than those hospitalized longer.

Safety is certainly an important consideration. But is a short hospital stay otherwise equivalent to a longer one? The kinds of studies needed to answer this question haven’t been done. "Early discharge can be cost saving, but we just don’t know if it is life saving," says cardiologist Arthur Moss, professor of medicine at the University of Rochester, who has been following this trend for more than a decade.

What you get in the hospital

During and immediately after a heart attack, a hospital is the place to be. You can get:

• pain relief
• a clot-busting drug or a procedure to open or bypass a blocked coronary artery
• fast treatment (a shock, or defibrillation) for an erratic and possibly deadly disturbance of your heart’s rhythm
• careful monitoring for signs of heart failure or other complications
• drug therapy and education to prevent another heart attack
• emotional and psychological support

There are also downsides to being in the hospital. Hospitals are havens for antibiotic-resistant bacteria, and some people pick up tough-to-treat infections during even brief stays. And medical errors, mostly in the form of medication mistakes, are an all-too-common consequence of hospitalization.

Ideally, you’d like to strike the right balance between staying long enough to get the care and education you need and leaving before anything bad happens.

Busy period

Once the immediate danger of a heart attack has passed and blood is flowing freely through the once-blocked artery, there’s still a lot to be done. At the top of the list is making sure the heart doesn’t lapse into an unstable rhythm or fall behind in pumping oxygen-rich blood to the body.

Gradually increasing activity is another priority. Gone are the days of enforced bed rest. In most hospitals, as soon as you are stable you’ll be encouraged to sit up, walk to the bathroom, and stroll the halls. This progressive exercise helps keep blood clots from forming. It also starts strengthening the heart and is a good check of its function — lack of chest pain is an excellent sign.

Starting or adjusting drug therapy is another crucial component of the hospital stay. The fact that you’ve had one heart attack puts you at risk for another. A number of medications can reduce this risk. The main ones are ACE inhibitors, beta blockers, statins, and aspirin. It takes some time to find the right dosages and watch for potentially dangerous interactions or side effects.

Recovery after a heart attack represents what’s often called a "teachable moment." It’s a time when people tend to be more open to giving up unhealthy habits and adopting healthy ones. Doctors and nurses take advantage of this vulnerability to start conversations about healthy eating, the benefits of daily physical activity, and stopping smoking. It’s also a good time to learn about the warning signs of depression, which is common after a heart attack.

Am I ready to go home?

The true meaning of this question has changed over the years. Once it was a plea to be released from the monotony of the hospital. Today it’s often uttered in surprise tinged with fear about going home too soon.

It’s a legitimate worry. In a survey of hospital stays of more than 4,000 heart attack survivors in Worcester, Mass., up to 1 in 4 were inappropriately sent home early. Here are a few tips to help you make sure you don’t leave the hospital before you are ready.

An early discharge is probably safe if you are younger (under age 75), didn’t develop complications such as signs of heart failure or heart rhythm problems, and have support at home.

Another litmus test is how you feel when you’re up and around in the hospital. "I walk the hospital hallways with my patients," says Dr. Morrow. "If they aren’t having chest pain or breathing problems, I can reassure them it’s safe to go home."

Your home situation should also influence your discharge. Do you live alone? Do you have to walk up several flights of stairs to get to your apartment? Do you take care of a spouse or someone else? These and other issues could either delay your discharge or at least make you eligible for home nursing or a home health aide.

One of the most important things to get before leaving the hospital is a referral to a cardiac rehabilitation program. It can give you information and help with healthy lifestyle changes that couldn’t possibly be crammed into a short hospital stay.

For most heart attack survivors, a short hospital stay is safe. It’s what you do afterward that really influences your long-term health.