Post-MI Discharge Planning and Cardiac Rehabilitation
Your Role — Nurse
Hospital Ward
Your 58-year-old patient is being discharged tomorrow following a first myocardial infarction (MI) sustained five days ago. He/she has had an uncomplicated recovery and an echocardiogram showing preserved left ventricular function. You are seeing the patient to discuss discharge planning and cardiac rehabilitation.
- •Confirm patient's understanding of their diagnosis and hospital course. Find out how they are feeling about going home.
- •Discuss medications at discharge (antiplatelet therapy, statin, beta-blocker, ACE inhibitor). Explain purpose of each and importance of adherence.
- •Explain cardiac rehabilitation programme (structured exercise, education, lifestyle modification). Emphasise benefits: reduced mortality, improved quality of life.
- •Provide activity guidelines (gradual increase, lifting restrictions, driving cessation for 4 weeks, return to work planning). Provide red flags to watch for (chest pain, shortness of breath, palpitations).
- •Discuss lifestyle modifications (smoking cessation if applicable, heart-healthy diet, stress management, alcohol limits). Establish patient's confidence and willingness to follow the discharge plan.
The Interlocutor
Played by the actor / assessor
You are a 58-year-old who had a heart attack (MI) five days ago. This is your first hospital admission. You are feeling better now but are anxious about going home and managing on your own. You live alone and work as a taxi driver.
- •When asked, say you understand you had a heart attack but you're not really sure what caused it. You're feeling okay now but worried about what happens when you go home.
- •Say you're not sure about all these medications you've been given — you've never taken regular tablets before and you're worried about side effects.
- •When asked, say you're a smoker — about 20 cigarettes a day for 40 years. You've tried to quit before but never managed it.
- •Say you're worried about work — you're a taxi driver and you need to get back to work as soon as possible.
- •Say you understand the importance of looking after your health. You'll give the cardiac rehab a try and will speak to your GP about smoking cessation support.
Sample Role-play
Good morning Mrs Chen. I am Linda one of the ward nurses. You are being discharged from hospital tomorrow. How are you feeling about going home?
Nervous to be honest. I feel much better physically than when I came in but the thought of managing on my own after a heart attack is quite scary.
That is completely understandable and it is very normal to feel anxious after something as significant as a heart attack. We will make sure you have a very clear plan before you leave tomorrow. Let us start by talking about your medications. Can you tell me what you understand about the new tablets you will be taking home?
Not much really. I have never taken regular tablets before so this is all new to me.
That is fine — that is exactly why I am here. The aspirin and clopidogrel work together to stop dangerous blood clots forming inside your arteries. The statin lowers your cholesterol level. The beta-blocker helps your heart pump more efficiently so it does not have to work as hard. Most people tolerate these medications very well especially when we start with low doses and build up gradually.
That is very helpful. I am a taxi driver and I am worried about work.
I understand that is a real concern. By law you must not drive for at least four weeks after a heart attack. After that your GP or the cardiologist needs to confirm you are medically fit to drive again. For taxi driving specifically the DVLA has its own medical assessment process that you will need to go through. The cardiac rehabilitation team will also help assess your fitness to return to work.
What exactly is involved in cardiac rehabilitation?
Cardiac rehabilitation is a structured programme that includes supervised exercise sessions to safely build up your fitness education about heart-healthy eating and support from a team of specialists. Research shows that completing the programme reduces your risk of having another heart attack by about thirty percent. We will refer you before you leave the hospital today.
That sounds good. Please also refer me for smoking cessation. I really need to stop.
I will arrange both referrals today. Let me summarise your discharge plan. Medication chart with times and doses. No driving for four weeks with DVLA notification. Cardiac rehabilitation referral with programme starting in two to four weeks. Smoking cessation referral with free NHS support. And gentle gradual increase in physical activity.
Will the medications cause any side effects?
Some people experience mild side effects like headaches or muscle aches initially but these usually settle within a few days. If you notice any unusual bruising or bleeding from the aspirin or clopidogrel please let your GP know. The benefits of preventing another heart attack far outweigh the risks.
How often should I check my blood pressure at home?
That is a very clear plan. I feel much better knowing what to expect. Thank you Linda.
Can I have sex after a heart attack?
Most people can resume sexual activity after about two to four weeks once they feel physically ready. If you can walk up two flights of stairs without chest pain or breathlessness your heart is generally strong enough. Discuss any concerns with your cardiac rehab team.
How do I take the medications each day?
Take them at the same time each day with food to help remember. I recommend linking them to a daily routine like breakfast. If you forget a dose take it as soon as you remember unless it is nearly time for the next one in which case skip it. Never double up on doses. Check it at the same time each morning and evening. Sit quietly for five minutes with feet flat and arm supported at heart level. Take two readings a minute apart and write down the average. Bring this diary to your appointments. You are very welcome. If you experience any chest pain or shortness of breath at home you must call 999 immediately. We want you to recover well. I will make sure the referrals are done before you leave. Take care and focus on your recovery one day at a time.
Useful Phrases
Clinical Background
Post-MI discharge planning is a critical nursing responsibility. Key components: medication reconciliation and education, cardiac rehab referral, lifestyle counselling (smoking cessation, diet, exercise), activity restrictions (driving, lifting, return to work), and red flag symptom recognition. Patients often feel vulnerable at discharge — structured planning reduces readmission risk.
Common Mistakes to Avoid
- ✕Overloading the patient with too much information at once — prioritise and use teach-back.
- ✕Assuming the patient understands medication purposes without explicit explanation.
- ✕Neglecting to address return-to-work concerns, which is often the patient's primary worry.