CORONARY HEART DISEASE (CHD) SELF MANAGEMENT PLAN  –   721                     REVIEW – 725   
Applies to acute coronary syndromes, myocardial infarction, coronary angioplasty with/without stenting, and bypass surgery.
  <<Practice:Name>>   Phone:   <<Practice:Phone>>  fax:   <<Practice:Fax>>	

Patient Details
 <<Patient Demographics:Full Details>>
	GP Details:
 <<Doctor:Full Details>>
     	Patient agreement for the GP Management Plan proceed
My GP has explained the steps & costs of the GP Management Plan & I agree to proceed.                                                       Yes            

Where I am referred to other service providers as listed on this GP Management Plan, I consent to my GP sharing                Yes                                                    
relevant information about myself to that provider. I have advised my GP of any information I wish to be withheld.            
 
I understand that   <<Practice:Name>> has one health record for patients and that this record is shared by                Yes    
all  <<Practice:Name>>  health team providers.                                                                                                                                                           .                                                                                                                                                           	

 Nature of the disease, Risk Factors and Co-morbidities (What is my condition?)  	
If you have coronary heart disease, the blood vessels that carry oxygen and nutrients to your heart muscle are clogged and narrowed. If these vessels (the coronary arteries) become too clogged, the blood supply to your heart muscle is reduced, which can lead to symptoms such as angina. If a blood clot forms in the narrowed artery and completely blocks the blood supply to part of your heart, it can cause a life-threatening heart attack.	

Impact of the Disease (what are my symptoms?)	
You may have just one of these symptoms, or you may have a combination of them. Symptoms can come on suddenly or develop over minutes and
get progressively worse. Symptoms usually last for at least 10 minutes.

Discomfort or pain in the centre of your chest: this can often feel like a heaviness, tightness or pressure. People who have had a heart attack have commonly described it as like an “elephant sitting on my chest” or “a belt that’s been tightened around my chest.” The discomfort may spread to different parts of your upper body.
Discomfort in these parts of your upper body: Arms, shoulders, neck, jaw and back. You may have a choking feeling in your throat. Your arms may feel heavy or useless.

You may also experience other signs and symptoms:
•	feel short of breath
•	feel nauseous
•	have a cold sweat
•	feel dizzy or light-headed.	

ACTION PLAN	

If above symptoms appear

1 STOP and rest

2 Talk to somebody and tell them how you fell
symptoms are severe? or getting worse? or lasted 10 minutes? 
(If you take angina medicine: • Take a dose of your medicine, Wait 5 minutes. Still have symptoms?Take another dose of your medicine. • Wait 5 minutes. Symptoms won’t go away?)

3 CALL 000 Ask for an ambulance. • Don’t hang up. • Wait for the operator’s instructions. (*If calling Triple Zero (000) does not work on your mobile phone, try 112.)

MANAGEMENT PLAN	
Medications	

Medicine	Recommendation
(Unless otherwise indicated, all recommendations derived from National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Reducing risk in heart disease 2008.)	
My role in this care plan  and Lifestyle changes 	
Who will do this?	
Antiplatelet agents 	Use aspirin 75–150 mg/day for all patients unless contraindicated.	     	     	
ACE inhibitors (ACEI)/Angiotensin II receptor antagonists (ARA)	Consider ACEI in all patients, especially those at high risk, unless contraindicated. Start early post myocardial infarction (MI). Consider ARA for patients who develop unacceptable side effects on ACEI.	     	     	
Beta-blockers	For all patients post MI, unless contraindicated, and continued indefinitely, especially in high-risk patients.
(High-risk patients are defined as those with either significant myocardial necrosis, left ventricular systolic dysfunction, persistent evidence of ischaemia or ventricular arrhythmia.)	     	     	
Statins	For all patients with CHD, unless contraindicated.	     	     	
Anticoagulants	Use warfarin in patients at high risk of thromboembolism 
post MI.	     	     	
Aldosterone antagonists	Epleronone may be used early post MI in patient with left ventricular systolic dysfunction and symptoms of 
heart failure.	     	     	
Medicine adherence	If poor adherence suspected, consider a Home Medicine Review.	     	     	
Other	     
	     	     	

Lifestyle/Psychosocial risk factors	
Risk factor	Recommendations
and targets	My role in this care plan  and Lifestyle changes	Who will do this?	
Smoking	Complete cessation 
and avoidance of second-hand smoke.	     	     	
Physical inactivity
	Progress, over time, to at least 30 minutes of moderate-intensity physical activity on most, if not all, days of the week (150 minutes per week minimum).	     	     	
Nutrition
	Establishment/
Maintenance of healthy eating patterns, with saturated and trans fatty acid intake ≤ 8% of total energy intake.	     	     	
Weight
	Waist measurement 
≤ 94 cm (males) or 
≤ 80 cm (females); 
BMI = 18.5-24.9 m2.	     	     	
Alcohol	Low risk alcohol consumption in people who drink < 2 standard drinks per day (males) or < 1 standard drink 
per day (females).	     	     	
Depression 	Assess all patients for co-morbid depression. Initiate psychosocial and medical management if appropriate.	     	     	
Social support	Assess all patients for level of social support and provide follow-up for people considered at risk by referral to cardiac rehabilitation and/or social worker or psychologist. 	     	     	
Other	     
	     	
     	

Biomedical risk factors	
Risk factor	Recommendations
and targets	My role in this care plan  and Lifestyle changes	Who will do this?	
Cholesterol/Lipids	LDL-C < 2.0 mmol/L; HDL-C > 1.0 mmol/L; Triglycerides 
< 1.5 mmol/L.	     	     	
Blood pressure	BP < 130/80 mmHg. For people with proteinuria  > 1 g/day (with or without diabetes): 
< 125/75 mmHg.
(National Heart Foundation of Australia. Guide to management of hypertension 2008.)	     	     	
Diabetes	Identify undiagnosed type 2 diabetes; maintain optimal BSL in those with diabetes (HbA1c ≤ 7%).	     	     	
Other conditions	     	     	
     	

Capacity to self manage	
 I have explored readiness for change and barriers for self management
 I have checked that the patient has enough  knowledge, confidence and family support to manage the condition	
Contacts and further Information	

For heart health information 1300 36 27 87 www.heartfoundation.org.au 

A copy of this plan has been given to the patient.        Yes                                           
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DATE COMPLETED:    <<Miscellaneous:Date (long)>>  	
This section is only to be completed at Review appointment
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Claim item 725