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It is recommended that patients who have restudied initially be followed up at least yearly for exercise and ischemic response and ECG studies. Exercise and pharmacologic stress testing can help to identify patients with poor prognosis who may benefit from subsequent therapy. 150 151

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The first 6 weeks after hospital discharge for an uncomplicated MI are a critical time for the effective management of cardiac risk factors. It is most important to monitor such risk factors as cholesterol, triglyceride, and blood pressure; obtain a cardiac history and risk factor assessment; prescribe an appropriate pharmacologic regimen; and perform a stress test. Risk factor control is critical in preventing recurrent MI or sudden death. With an aggressive, well-organized therapeutic program (including the use of lipid-lowering drugs and aspirin) effective prevention of recurrent MI and sudden death is achievable in the majority of patients with one or more CHD risk factors and in those with one or two additional risk factors. 217

The Task Force recommends that exercise and stress testing be used to evaluate the degree of disease in subjects with known CAD. 218 See the ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1998 Guidelines for the Management of Patients With Acute Myocardial Infarction).

In patients without overt heart failure at the time of discharge, the average heart rate in exercise tests decreases during the first 6 months after MI. 220 Similarly, when stress testing is performed, resting heart rate declines in the early post-MI period. Thus, a normal resting ECG may be a useful clinical screening test for post-MI subclinical heart failure. 221

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