Excerpt

This guideline gives recommendations to clinicians and others about lifestyle modification, cardiac rehabilitation, drug therapy and advice about which patients to refer for further assessment for possible coronary revascularisation.

Contents

• Preface
• 1. Key priorities for implementation
• 2. Introduction
  • 2.1 Background (Epidemiology)
  • 2.2 Management
  • 2.3 Aim of the guideline
  • 2.4 How the guideline is set out
  • 2.5 Scope
  • 2.6 Responsibility and support for guideline development
  • 2.7 Care pathway
  • 2.8 Research recommendations
  • 2.9 Acknowledgements
  • 2.10 Glossary
• 3. Methods
  • 3.1 Introduction
  • 3.2 Developing Key Clinical Questions
  • 3.3 Literature search strategy
  • 3.4 Identifying the Evidence
  • 3.5 Critical appraisal of the evidence
  • 3.6 Economic analysis
  • 3.7 Assigning levels to the evidence
  • 3.8 Forming recommendations
  • 3.9 Areas without evidence and consensus methodology
  • 3.10 Consultation
  • 3.11 The Relationship between the guideline and other national guidance
• 4. Lifestyle
  • 4.1 Recommendations for lifestyle
  • 4.2 Effectiveness of changing dietary regimen
  • 4.3 Delivery of dietary advice
  • 4.4 Alcohol consumption
  • 4.5 Regular physical activity
  • 4.6 Smoking cessation
  • 4.7 Weight management
• 5. Cardiac rehabilitation
  • 5.1 Recommendations for cardiac rehabilitation
  • 5.2 Comprehensive cardiac rehabilitation
  • 5.3 Patient engagement
  • 5.4 Education and information provision
  • 5.5 Psychological and social support
  • 5.6 Sexual Activity
• 6. Drug Therapy
  • 6.1 Recommendations for Drug Therapy
  • 6.2 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)
  • 6.3 Antiplatelet therapy
  • 6.4 Beta blockers
  • 6.5 Vitamin K antagonists
  • 6.6 Calcium channel blockers
  • 6.7 Potassium channel activators
  • 6.8 Aldosterone antagonists in patients with heart failure and LV dysfunction
  • 6.9 Lipid lowering agents
  • 6.10 Monitoring guidance
• 7. Coronary revascularisation
  • 7.1 Coronary revascularisation recommendations
  • 7.2 Clinical effectiveness of coronary revascularisation
  • 7.3 Health economics
• 8. Selected patient subgroups
  • 8.1 Patients with hypertension
  • 8.2 Patients with left ventricular dysfunction
  • 8.3 Patients with a proven MI in the past (greater than 1 year)
• 9. Communication of diagnosis and advice
  • 9.1 Communication of diagnosis and advice recommendations
• Reference List
• Appendices
  • Appendix A Scope
  • Appendix B Health Economic Modelling
  • Appendix C Clinical Evidence Extractions
  • Appendix D Health Economic Extractions
  • Appendix E Clinical Questions and Search Strategy
  • Appendix F National Service Framework for Coronary Heart Disease definition of phases of comprehensive cardiac rehabilitation
  • Appendix G Omega-3 fatty acids content of various oily fish required to provide approximately 1 g of EPA plus DHA per day

Full guideline - Final Version

The guideline updates the previous NICE guideline entitled ‘Prophylaxis for patients who have experienced a myocardial infarction’ 2001. The guideline has updated the previous guideline’s information on drug therapy. The guideline has enlarged the information on cardiac rehabilitation and lifestyle chages provided in the previous guideline, to reflect the the remit of the scope of the guideline.

Suggested citation:

Cooper A, Skinner J, Nherera L, Feder G, Ritchie G, Kathoria M, Turnbull N, Shaw G, MacDermott K, Minhas R, Packham C, Squires H, Thomson D, Timmis A, Walsh J, Williams H, White A. (2007) Clinical Guidelines and Evidence Review for Post Myocardial Infarction: Secondary prevention in primary and secondary care for patients following a myocardial infarction London: National Collaborating Centre for Primary Care and Royal College of General Practitioners.