Introduction

Acute myocardial infarction remains a common cause of death worldwide. Despite decreases in mortality from coronary heart disease in most developed countries, mortality is increasing in most eastern European countries and developing countries.1 In the United Kingdom 1.2 million people are estimated to have survived heart attacks, yet few survivors are offered comprehensive cardiac rehabilitation.2 Effective implementation of secondary prevention is a great challenge,^w1 and lack of implementation has been described as a collective failure of medical practice, as clear evidence shows that several interventions could reduce the risk of recurrent disease and death.3

Primary care's challenge is to make this happen. Two recent initiatives will change the face of secondary prevention in British primary care:

• The national service framework for coronary heart disease advocates the use of disease registers in primary care to provide long term follow up of patients with coronary heart disease and setsstandards and milestones for secondary prevention^w2

• The imminent general medical services contract includes funding to encourage primary care teams to implement evidence based care.^w3

Growing evidence shows suboptimal application of secondary prevention, and examples show how evidence based practice can be applied in primary care to improve the quality of care for patients with coronary heart disease.3^–6 The number of patients in each practice, the benefits of continuity and the high frequency of comorbidity, and psychosocial problems have increased the role of the generalist. This puts primary care in the vanguard of saving lives.7 This review thus focuses on topics related to primary care.

Sources and selection criteria

We searched Medline for relevant reviews related to secondary prevention (after acute myocardial infarction) and papers published in the past three years; …