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Practice Guidelines

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

BMJ 2013; 347 doi: (Published 13 November 2013) Cite this as: BMJ 2013;347:f6544
  1. Katie Jones, project manager1,
  2. Leanne Saxon, research fellow1,
  3. William Cunningham, retired general practitioner2,
  4. Phil Adams, emeritus consultant cardiologist3
  5. on behalf of the Guideline Development Group
  1. 1Royal College of Physicians, National Clinical Guideline Centre, London NW1 4LE, UK
  2. 2Hadrian Primary Care Alliance, Corbridge, UK
  3. 3Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
  1. Correspondence to: K Jones katie.jones{at}

Acute management of people who have had a myocardial infarction (MI) has changed dramatically, with more people surviving. More effective treatment, including percutaneous coronary intervention, raises questions about the relevance of current recommendations on secondary prevention. Concerns have arisen about the need for the antiplatelet regimens mandated by coronary stent insertion in people who have an independent need for warfarin. New data are also available about how to increase attendance for cardiac rehabilitation programmes, about existing drug treatments and lifestyle advice, and new antithrombotic agents.

The impact of shorter stays in hospital on the changes in acute management have emphasised the importance of primary care in secondary prevention. General practitioners and nurses are now responsible for most of this activity, specifically the promotion of cardiac rehabilitation programmes and the prescription and monitoring of ongoing drug therapy. This also requires effective communication between hospital and primary care, ensuring that clear management plans are relayed in a timely way.

These considerations have led to a revision of the 2007 guideline on secondary prevention after an MI.1 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).2


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Cardiac rehabilitation

Cardiac rehabilitation should be offered to all people who have had an MI and should be provided in different settings (such as in the person’s home) and at different times of the day to ensure that people can attend and complete the programme.

  • Offer cardiac rehabilitation programmes designed to motivate people to attend and complete the programme. …

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