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Practice NICE guidelines

Secondary prevention for patients after a myocardial infarction: summary of NICE guidance

BMJ 2007; 334 doi: (Published 24 May 2007) Cite this as: BMJ 2007;334:1112
  1. J S Skinner, consultant community cardiologist1,
  2. A Cooper, senior health services research fellow2,
  3. G S Feder, professor of primary care research and development3
  1. 1Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  2. 2National Collaborating Centre for Primary Care, Royal College of General Practitioners, London
  3. 3Barts and the London Queen Mary's School of Medicine and Dentistry, London
  1. Correspondence to: J S Skinner Jane.Skinner{at}

    This is one of a series of BMJ summaries of new NICE guidelines, which are based on the best available evidence; they will highlight important recommendations for clinical practice, especially where uncertainty or controversy exists.

    Why read this summary?

    Although premature mortality from coronary heart disease in the United Kingdom has fallen since the 1970s, it remains higher than in most other Western countries. After an acute myocardial infarction, many eligible patients are prescribed aspirin, β blockers, angiotensin converting enzyme inhibitors, and statins. Not everyone, however, is offered the most effective secondary prevention1 2—that is, all four of these drugs or other effective drugs—nor does everyone receive lifestyle advice and cardiac rehabilitation. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on effective secondary prevention in patients after myocardial infarction.3 The detailed consideration of the evidence is available in the full guideline (


    NICE recommendations are based on systematic reviews of best available evidence. For the guidance on secondary prevention for patients after a myocardial infarction, in cases where minimal evidence was available, the guideline development group developed the recommendations on the basis of their own opinions and those of leading specialists; such recommendations are indicated with an asterisk (*).

    Every discharge summary after a myocardial infarction should confirm this diagnosis and include results of investigations, future management plans, and advice on secondary prevention.*


    Lifestyle advice should be consistent and take account of patients' current habits; any changes should be tailored to the individual.

    Advise patients:

    • • To take enough regular physical activity to increase exercise capacity (reduces total mortality), building this up to 20-30 minutes a day to the point of slight breathlessness

    • • To quit smoking. Offer support, advice, and pharmacotherapy to those wishing to quit4 5

    • • To …

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