Emergency Department and Hospital Preventive Care of Elderly Next of Kin of Victims of Sudden Cardiac Death and Fatal Acute Myocardial Infarction
To the Editor:
Many studies have demonstrated that the bereaved are at increased risk for dying, especially in the weeks to months after the loss of a spouse.1 The excess mortality is primarily from heart disease. Most elderly spouses will accompany the victim to the emergency department (ED) or coronary care unit (CCU). This presents a golden and perhaps the only opportunity for prevention of impending death of the next of kin.
Here are some suggested measures for preventing cardiac death of the bereaved by ED or CCU nursing staff and, if indicated, by physicians2: (1) check survivor’s vital signs and ask about acute vascular symptoms and medication history; (2) if significant blood pressure elevation or other abnormalities are found, admit to the ED and evaluate; (3) schedule and/or advise survivor to visit a personal physician within 2 weeks and to continue all medications; (4) prescribe a 2-week supply of a benzodiazepine for sedation; and (5) give the survivor a set of materials from the Heart Attack Education Campaign, Act in Time to Heart Attack Signs (see http://www.americanheart.org).
Follow-up care by the primary care physician should occur within 2 weeks of the event and include the following steps: (1) evaluate for cardiovascular symptoms and signs and medication noncompliance; (2) evaluate and treat for uncontrolled anxiety, depression, and insomnia and refer the patient for acute grief counseling as needed; (3) give the survivor a set of materials from the Heart Attack Education Campaign, Act in Time to Heart Attack Signs (see http://www.americanheart.org); and (4) follow up in 2 to 4 weeks.3
Launched in 2001, Act in Time to Heart Attack Signs, a new heart attack education campaign, urges physicians and nurses to educate their patients about heart attack warning signs and the need to react quickly by calling 9-1-1.4 Patient education materials developed by campaign cosponsors, the National Heart, Lung, and Blood, Institute and the American Heart Association, are ideally suited for elderly next of kin for the prevention of sudden death and fatal acute myocardial infarction.5
- ↵Raphael B, Martinek N. Bereavements and trauma. In: Jenkins R, Ustun TB, eds. Preventing Mental Illness: Mental Health Promotion in Primary Care. New York, NY: John Wiley & Sons, Ltd; 1998: 354–375.
- ↵Helsing KJ, Szklo M. Mortality after bereavement. Am J Epidemiol. 1981; 114: 41–52.
- ↵Faxon D, Lenfant C. Timing is everything: motivating patients to call 9-1-1 at onset of acute myocardial infarction. Circulation. 2001; 104: 1210–1211.
- ↵Ornato JP, Hand MM. Cariology patient page: warning signs of a heart attack. Circulation. 2001; 104: 1212–1213.