A medical professional talks to a patient with the data and information on a clipboard.
Each additional recommendation a heart attack survivor follows could reduce their risk of death by 8% to 11%. (For Spectrum Health Beat)

Heart attack survivors receive a laundry list of tasks from their doctors as they leave the hospital, all aimed at improving their heart health.

It would be understandable to look at the list with a raised eyebrow and ask just how important all of it is.

Vitally important, it turns out.

Heart patients who follow all of their doctor’s recommendations have a much lower risk of death than those who only follow some or most of them, according to a new study published recently in the Journal of the American Heart Association.

Each additional recommendation a patient follows appears to reduce their risk of death by between 8% and 11%, researchers found.

Patients who faithfully followed all seven recommendations had a 43% lower risk of death compared to those who followed three or fewer.

That benefit decreased with the number of recommendations followed, from six (31%) to five (25%) to four (16%).

“All of them are important,” said senior researcher Dr. Alan Go, associate director of cardiovascular and metabolism research at Kaiser Permanente Northern California. “If you only get to four, there’s value to getting to five and in going from five to six and from six to seven.”

For this study, Kaiser Permanente researchers followed more than 25,000 heart attack survivors after their discharge from the hospital.

The survivors were each given seven tasks or goals intended to help them live longer and prevent future heart attacks. These included:

  • Taking an ACE inhibitor or ARB medication.
  • Taking a beta blocker.
  • Taking blood thinners.
  • Taking cholesterol-lowering medications.
  • Controlling their blood pressure.
  • Quitting smoking.
  • Reducing their “bad” LDL cholesterol levels.

“The amazing therapies we can provide at the time of a heart attack these days, like stents and IV medicines in the hospital, really are just the beginning of a long journey toward wellness and improving your heart health,” said lead researcher Dr. Matthew Solomon, a cardiologist with Kaiser Permanente’s Oakland Medical Center. “There are many things patients need to do after the heart attack.”

Doctors checked in with patients at one month and three months after their discharge to see how well the survivors had complied with this list of heart-saving measures.

They then tracked the patients for six years, from 2008 to 2014, to see whether these recommendations had any effect on patients’ long-term survival.

“We wondered, ‘Are there going to be diminishing returns?'” Solomon said. “We don’t have great information for patients who follow all of the recommendations. Do they do as well as people who only follow some of them?”

About 23% of patients were able to stick with all seven recommendations by three months following their hospital discharge—and they had the lowest risk of death, the researchers found.

“Given that a majority of people did not follow all of the guidelines, there is a substantial opportunity for clinicians, health care systems, communities and patients to improve,” said Dr. Richard Becker, director of the University of Cincinnati’s Heart, Lung and Vascular Institute, adding that such action “promises to be lifesaving.” He wasn’t involved with the study.

The results show the importance of cardiac rehabilitation programs aimed at preventing second heart attacks, Solomon said.

Unfortunately, typical nationwide participation in cardiac rehab programs is around 30%, Solomon noted. Kaiser Permanente offers a comprehensive home-based cardiac rehab, and its enrollment is 77%.

Kaiser Permanente heart patients receive an exercise prescription and a care plan that targets smoking cessation, medication adherence, cholesterol management, blood pressure control, dietary advice, stress reduction and weight management.