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The recently published NICE guideline MI: secondary prevention in primary and secondary care for patients following a myocardial infarction1 updates the previous guideline published in 20012 and the relevant sections of the National Service Framework for coronary heart disease.3 The guideline is important to clinicians in both primary and secondary care, and to those who plan services. There have been significant improvements in recent years and the majority of eligible patients leaving hospital after an acute myocardial infarction are now treated with aspirin and statins. However, other important interventions such as advice about lifestyle and cardiac rehabilitation are less consistently provided and there is inconsistent practice with regards to some drug therapies. This guideline makes recommendations for lifestyle and cardiac rehabilitation in far greater detail than in the previous one, as well as updating and expanding the recommendations for drug treatment.
Patients who have just had an acute myocardial infarction are readily identifiable, and this guideline addresses secondary prevention after the very early acute phase. It also makes recommendations for the management of patients with a proven myocardial infarction in the past. These patients will generally no longer be under hospital follow-up and it will be the responsibility of primary care to review patients on their disease registers to ensure that management has been optimised.
The recommendations that aspirin, beta blockers, statin and ACE inhibitors be considered in all patients after acute myocardial infarction are maintained in this guideline and further supplemented to include appropriate treatment with a combination of aspirin and clopidogrel, and early treatment with an aldosterone antagonist in patients with heart failure. Other drugs such as vitamin K antagonists are also now included.
Recommendations for treatment with the combination of aspirin and clopidogrel in non-ST elevation myocardial infarction restate those of the NICE …
Funding: This work was undertaken by National Collaborating Centre for Primary Care which received funding from the National Institute for Health and Clinical Excellence.
Competing interests: Dr Skinner was the clinical advisor for the NICE guideline for secondary prevention after MI and both Dr Skinner and Dr Minhas were members of the Guideline Development Group. During the last five 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 two years. During the last 12 months Dr Minhas has not received any honoraria and travel grants and over the preceding four years has received honoraria and travel grants from several pharmaceutical companies that manufacture cardiovascular therapies.
The views expressed in this publication are those of the authors and not necessarily those of the Institute.