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Mortality from coronary heart disease has been falling in the UK since the 1970s, but remains higher than in most other Western countries. Most patients receive some treatment for secondary prevention after myocardial infarction, but not all patients are offered the most effective secondary prevention package. The recently published NICE guideline for secondary prevention in patients after myocardial infarction, summarised in this article, makes clear recommendations for management of patients after myocardial infarction, based on best available evidence. The guidelines update the 2001 NICE guideline, and have expanded and emphasised the recommendations for physical activity, dietary and other lifestyle changes, and cardiac rehabilitation, and updated the recommendations for drug therapy.
Although mortality from coronary heart disease in the UK has fallen since the 1970s, it remains higher than in most other Western countries, with over 103000 deaths per year. Since the publication of the National Service Framework for coronary heart disease in 2000,1 many patients are prescribed aspirin, beta blockers, ACE inhibitors and statins following myocardial infarction. However, not everyone is offered the most effective package for secondary prevention. Patients are not always prescribed all four of these drugs or other effective drugs, nor do they always receive advice about lifestyle changes and access to cardiac rehabilitation. This guideline clearly sets out the recommendations for effective secondary prevention in patients after myocardial infarction. It updates the 2001 NICE guideline Prophylaxis for patients who have experienced a myocardial infarction.2 The recommendations for physical activity, dietary changes and rehabilitation have been expanded and emphasised, and the recommendations for drug therapy updated. The guideline makes recommendations for patients after an acute myocardial infarction and also for those who have had a proven myocardial infarction at any time in the past.
The detailed consideration of the evidence for this guideline is available in the full version (see http://www.nice.org.uk/CG048).
NICE recommendations are based on systematic reviews of best available evidence. For guidance on secondary prevention for patients after a myocardial infarction, in cases where minimal evidence was available, the guideline development group created the recommendations on the basis of their own opinions and those of leading specialists; such recommendations are indicated with an asterisk (*).
After a myocardial infarction, confirmation of the diagnosis of acute myocardial infarction and results of investigations, future management plans and advice on secondary prevention should be part of every discharge summary*.
Lifestyle advice should be consistent, take account of patients' current habits and any changes tailored to the individual.
Patients should be advised to:
Patients should be advised against taking:
Cardiac rehabilitation should be actively promoted by all healthcare professionals, including senior medical staff, involved in providing care for patients after a myocardial infarction*.
Funding: The National Collaborating Centre for Primary Care was commissioned and funded by the National Institute for Health and Clinical Excellence to write this summary.
Competing interests: All authors were members of the Guideline Development Group for the NICE guideline for secondary prevention after myocardial infarction. Dr Skinner was the clinical advisor, Dr Cooper the lead systematic reviewer and Professor Feder chaired the guideline development group. During the last 5 years Dr Skinner has received travel grants to attend educational meetings from Novartis, Pfizer and Sanofi Synthelabo/Bristol Myers Squibb Pharmaceuticals, with none during the last 2 years.
Declaration: A similar summary of this guideline has also been published in the BMJ 2007;334:1112–13.