The National Institute for Health and Care Excellence (NICE) is updating its guidance to improve the care of people who have survived a heart attack.

The draft guideline published today for public consultation contains a number of important new recommendations and aims to improve the care received by hundreds of thousands of adults in England and Wales who have survived a heart attack. The guideline, originally published in 2007, is centred on stemming the progression of vascular disease as well as preventing further heart attacks (myocardial infarctions).

Heart attacks are usually caused by a blockage in the coronary artery, a preventable complication of coronary heart disease. Since the late 1990s there has been a reduction in deaths caused by heart attacks, largely as a result of changes in treatments given immediately following a heart attack and the use of therapies to prevent secondary heart attacks. Even so, heart attacks remain a common cause of death and continuing ill health.

The draft guideline expands on previous recommendations about programmes to help people recover after a heart attack because, despite the 2007 guidance, the uptake of these remains relatively low. The draft guideline therefore includes interventions which aim to ensure more people take up and complete cardiac rehabilitation programmes.

Major changes in the treatments given immediately after a heart attack since the original guideline was published, particularly the use of interventional procedures such as using stents rather than drugs as a means of widening blocked or narrowed coronary arteries (primary percutaneous coronary intervention), have also been taken account of in the updated guideline.

The draft guideline no longer recommends eating oily fish, or taking omega-3 fatty acid capsules or omega-3 fatty acid supplemented foods specifically for the prevention of further heart attacks. New evidence shows that the risk of further cardiovascular events such as heart attacks or strokes, is very different today because of the new treatments that are now available. This means that any impact an oily fish diet may have on preventing further heart attacks or strokes could be minimal. The draft guideline does, however, continue to recommend that people who have had a heart attack eat a Mediterranean-style diet - more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on plant oils.

Updated recommendations in the draft guideline also include those on the use of drugs after a heart attack. These reflect new findings on treatments to prevent blood clots (antithrombotic therapy) and on the use of drugs to reduce blood pressure and control heart rhythm and rate such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and beta-blockers.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Despite the improvements in the number of people surviving a heart attack, heart disease remains the UK's biggest killer, causing more than 80,000 deaths each year. It also causes ongoing health problems for many thousands of others. People who have had a heart attack have a greatly increased risk of another. This updated draft guideline takes on board the latest evidence on the best ways to prevent further heart attacks or strokes in people who have already suffered a heart attack. Its aim is to provide the growing number of people who now survive a heart attack with the good quality, systematic care that is essential to improving long term outcomes and quality of life.”

“Healthcare professionals should ensure that a programme of education and activity to help people recover from a heart attack and lead their lives as normally as possible, is designed to motivate people to attend and complete it. The programme should begin as soon as possible, and before people leave hospital. People who have had a heart attack should also be encouraged to eat a healthier, Mediterranean-style diet, and exercise daily in order to reduce their risk of a further heart attack. The guideline will help ensure there is continued progress in reducing the number of premature, preventable deaths in people who have had a heart attack.”

Ends

Notes to Editors

About the draft guideline

1. The draft guideline on the secondary prevention of myocardial infarction in primary and secondary care will be available on the NICE website from 13 June 2013. Embargoed copies are available on request from the NICE press office.

2. Only registered stakeholders can submit comments on the draft guideline during this consultation. This is inline with the consultation process for NICE clinical guidelines. Organisations and patient groups can register to become a stakeholder at any time during the guideline development process.

3. Changes seen on an electrocardiogram (ECG) help to divide heart attacks into 2 distinct types: ST-segment elevation myocardial infarction (STEMI) generally caused by complete and persisting blockage of the artery; and non-ST-segment elevation myocardial infarction (NSTEMI), reflecting partial or intermittent blockage.

4. In England and Wales in 2011 more than 79,000 hospital admissions were caused by heart attacks. Of these 41% were STEMIs and 59% NSTEMIs. Twice as many men had heart attacks as women. There are currently around 1 million men and nearly 500,000 women who have had an MI in the UK.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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