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P atients with a new diagnosis of acute coronary syndrome (ACS) often do not know a great deal about their disease, its treatment, or the lifestyle changes needed to prevent recurrence. 1 Restenosis is common (39% of patients) after percutaneous coronary intervention. 2 In addition, ACS recurrence lowers qual- ity of life and is expensive. 2 Pharmacists have the ability to improve outcomes and increase the quality of life of their patients. Early, individualized education leads to better self-care and greater satisfaction with that care. 1 Also, family and health care social support increases the perceived benefit, 2 which improves adherence with self-care and thereby improves outcomes. 2 Self-Care Self-care (eg, smoking cessation, regu- lar health checks, medication adherence, diet, exercise) can prevent recurrence of ACS, but long-term adherence to self-care is key. Adherence to self-care depends on a patient's beliefs, disease knowledge, overall ability to function, emotions (eg, anxiety, depression), and outside influences (eg, social and health care networks). Disease knowledge includes knowing about ACS characteris- tics, risk factors, medications, and dietary and exercise needs. Knowing more does not affect a patient's anxiety, depression, or valuation of the benefits of self-care. 2 Self-efficacy, which includes the ability to manage one's own medications, smok- ing, diet, and exercise, notably influences self-care. Encourage your patients to see past the likely occurrence of reduced body function. Help them understand there will be setbacks that increase the perception of barriers, which can be overcome with a positive attitude. 2 Patients may not like hearing it, but improvements in diet, as well as exercise and smoking cessation, can help. Most individuals will adhere to self- care for a month after they are given an ACS diagnosis, but adherence drops at about 6 months after discharge from the hospital. 2 Smoking, combined with a lack of exercise or dietary restraint, for even 6 months after an ACS incident, increas- es nearly 4-fold the incidence of acute myocardial infarction, stroke, and death. 2 Regular monitoring and education on the benefits of diet and exercise, can improve patient adherence to healthy behaviors. 2 Lack of exercise, including excessive sitting, increases cardiac morbidity and mortality. 3 At least a half hour of mod- erate exercise 5 times per week is rec- ommended for patients who have been cleared for exercise by their doctor. 3 Even moving, rather than sitting for extended periods, has health benefits for everyone. 3 Having a workout program increases the likelihood of continuing to exercise. 2 It has repeatedly been shown that heart health can be improved and heart attacks prevented by having a healthy diet; engaging in physical activity; maintain- ing a healthy body weight, blood pressure and cholesterol levels; and reducing or eliminating alcohol and smoking. Healthy diets known to help patients with ACS, include the Mediterranean diet and a diet high in fruits, vegetables, whole grains, and seafood, with limited salt and sugar. Simply having a healthy diet and limiting alcohol reduces heart attack risk by one- third. The combination of a healthy diet, moderate alcohol use, moderate exercise COUNSELING FOCUS 52 PharmacyTimes.com December 2015 Acute Coronary Syndrome y How to Empower Patients Debra Freiheit, RPh