OET letter after a heart attack: stents, new medicines and cardiac rehab referral
In an OET Nursing letter about a patient discharged after a heart attack, state the event and the treatment in one or two sentences, then focus on what the reader must manage: new medicines and why they matter, activity and driving advice given, risk factors to address, and the follow-up or cardiac rehabilitation you are requesting. Leave out serial ECG and troponin results unless the reader needs a value to act on.
What the reader needs after a heart attack
Cardiac case notes can be long: chest pain timeline, ambulance observations, ECG changes, troponin levels, the angiogram, where the stent was placed, echo findings and a new medicine list. The reader of your letter, usually a cardiac rehabilitation nurse, a GP or a practice nurse, does not need to repeat the hospital work-up. They need to know:
- What happened, in one or two sentences.
- What treatment was given, briefly.
- What has changed in the patient's medicines and daily life.
- What risks remain, such as smoking, high blood pressure, diabetes or low mood.
- What you want them to do.
For the general approach to choosing notes, see how to select case notes.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| Event and date in one sentence | Minute-by-minute chest pain timeline |
| Treatment (e.g. a stent was inserted) | Which coronary artery and the stent brand |
| New medicines and the purpose of key ones | Medicines given only in the emergency department |
| Advice already given (activity, driving, warning signs) | Detailed ward routine |
| Risk factors that need follow-up | Normal results needing no action |
| Patient's understanding, mood and worries | Unrelated past history (old sports injuries) |
| Appointments and tests booked or needed | Every blood pressure reading |
Turning cardiac notes into sentences
| Notes | Letter sentence |
|---|---|
| Adm 2/9 central CP, STEMI, PCI x1 stent | "He was admitted on 2 September with a heart attack and had a stent inserted the same day." |
| Commenced aspirin, ticagrelor, atorvastatin, bisoprolol, ramipril | "He was started on five new medicines, including two that prevent clotting in the stent." |
| Must not stop antiplatelets w/o cardiology advice | "It is important that he does not stop his blood-thinning medicines without advice from the cardiology team." |
| Smoker 20/day, keen to quit | "He smokes 20 cigarettes a day and says he wants to stop." |
| Anxious re returning to work (builder) | "He is anxious about returning to his physical work as a builder." |
| Echo: heart pump mildly reduced | "A heart scan showed that his heart is pumping slightly less well than normal." |
| No driving 4/52 – advised | "He has been advised not to drive for four weeks." |
Notice that the medicine sentence groups the medicines and explains the safety point, rather than listing five drug names with doses. If the reader needs exact doses, a short list is acceptable; see medications in OET letters.
The driving and activity periods in this guide are invented for the example. In a real test, copy whatever the case notes say.
Choosing the right detail for the reader
- Cardiac rehabilitation nurse: event, treatment, heart function if given, risk factors, mobility, work and lifestyle goals, mood.
- GP: new medicines and any to monitor or adjust, blood tests due, risk factors, referrals already made.
- Practice or community nurse: blood pressure checks, medicine support, smoking cessation, wound site if relevant.
- Patient or family: plain words, warning signs, what to do if pain returns, who to call. See writing to a non-clinical reader.
Worked example (invented case)
Case summary (invented): Mr Liam Forde, 52, builder, lives with partner and two teenagers. Admitted 2 September with central chest pain; heart attack confirmed, one stent inserted the same day. Heart scan: pumping slightly reduced. New medicines: aspirin, ticagrelor, atorvastatin, bisoprolol, ramipril; told not to stop the first two without cardiology advice. Smokes 20/day, wants to quit; referral to stop-smoking service accepted. BMI 31. Father died of heart attack aged 60. Anxious about work, asking when he can lift. Advised no driving for four weeks. Plays darts weekly. Appendix removed age 14. Discharge 6 September. Task: refer to the cardiac rehabilitation nurse.
Selection decisions:
- In: event and stent, reduced pumping, new medicines and the antiplatelet warning, smoking and referral, weight, family history, work anxiety and lifting questions, driving advice.
- Out: darts, appendix, chest pain timeline, troponin values.
Sample letter body:
Dear Cardiac Rehabilitation Nurse,
Re: Mr Liam Forde, aged 52
I am writing to refer Mr Forde, who was discharged today following a heart attack, to your cardiac rehabilitation programme.
Mr Forde was admitted on 2 September with central chest pain and had a stent inserted the same day. A heart scan showed that his heart is pumping slightly less well than normal. He has been started on five new medicines, including aspirin and ticagrelor to prevent clotting in the stent, and he understands that he must not stop these without advice from the cardiology team.
He smokes 20 cigarettes a day and has accepted a referral to the stop-smoking service. He is also overweight, and his father died of a heart attack at 60.
Mr Forde works as a builder and is anxious about when he can return to lifting. He has been advised not to drive for four weeks.
I would be grateful if you could assess him for your programme, advise him on a safe return to physical work and support him in reducing his risk factors. Please do not hesitate to contact me if you require further information.
Yours sincerely,
The opening states the purpose straight away, the body moves from event to medicines to risks to the patient's concerns, and the request picks up the work anxiety and risk factors raised earlier.
Practise timed letters at /writing/, or check a letter you have written for an estimated grade and a mark on each of the six criteria.
Mistakes to avoid
- Retelling the emergency. The reader needs the outcome, not the ambulance timeline.
- Listing medicines without purpose. One sentence on why the key medicines matter is more useful than five doses.
- Cardiac abbreviations. STEMI, PCI, LAD and EF are unclear to many readers.
- Judgemental wording about lifestyle. "He refuses to look after himself" is not appropriate. State the facts and what has been offered.
- A request that ignores the patient's worries. If you mention his anxiety about work, address it in the request.
Related: heart failure patient letters, OET nursing referral letters and opening sentence examples.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines, time periods and plans are invented for practice and must not be used to guide care. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.