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Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease [CG172]

Measuring the use of this guidance

Recommendation: 1.1.1

All patients (regardless of their age) should be given advice about and offered a cardiac rehabilitation programme with an exercise component.

What was measured: The proportion of people post myocardial infarction who attended a cardiac rehabilitation programme.
Data collection end: March 2016
39%
Area covered: England
Source: The British Heart Foundation. National audit of cardiac rehabilitation.

What was measured: The proportion of people post myocardial infarction and percutaneous coronary intervention who attended a cardiac rehabilitation programme.
Data collection end: March 2016
58%
Area covered: England
Source: The British Heart Foundation. National audit of cardiac rehabilitation.


Recommendation: 1.3.1

Offer all people who have had an acute MI treatment with the following drugs: • ACE (angiotensin-converting enzyme) inhibitor • dual antiplatelet therapy (aspirin plus a second antiplatelet agent) • beta-blocker • statin.

What was measured: Proprtion of patients with a history of myocardial infarction (on or after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and statin
Data collection end: March 2015
69.1%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for beta-blocker.
Data collection end: March 2015
96.6%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for either ACE inhibitor or angiotensin receptor blocker.
Data collection end: March 2015
94.6%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for statins.
Data collection end: March 2015
97.4%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for either clopidogrel or prasugrel or ticagrelor
Data collection end: March 2015
97.5%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The overall proportion of patients were discharged taking all the secondary prevention drugs for which they were eligible
Data collection end: March 2015
90.5%
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for either ACE inhibitor or angiotensin receptor blocker.
Data collection end: March 2016
94.7%
Number that met the criteria: 51003 / 53853
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for statins.
Data collection end: March 2016
97.43%
Number that met the criteria: 53243 / 58247
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for either thienopyridine inhibitor or ticagrelor.
Data collection end: March 2016
97.24%
Number that met the criteria: 55461 / 57034
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.

What was measured: The overall proportion of patients were discharged taking all the secondary prevention drugs for which they were eligible
Data collection end: March 2016
90.5%
Number that met the criteria: 57506 / 63544
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.


Recommendation: 1.3.1

Offer all people who have had an acute MI treatment with the following drugs: ACE (angiotensin-converting enzyme) inhibitor dual antiplatelet therapy (aspirin plus a second antiplatelet agent) beta-blocker statin.

What was measured: The proportion of patients discharged from medical care following heart attack that are eligible and received a prescription for beta-blocker.
Data collection end: March 2016
96.6%
Number that met the criteria: 53243 / 55129
Area covered: National
Source: National Institute for Cardiovascular Outcomes Research. Myocardial Ischaemia National Audit Project.


Recommendation: 1.3.12

Offer aspirin to all people after an MI and continue it indefinitely, unless they are aspirin intolerant or have an indication for anticoagulation.

What was measured: The percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken
Data collection end: March 2015
91.7%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: CHD005: The percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken.
Data collection end: March 2016
91.8%
Data collection end: March 2017
91.9%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.3.40

For patients who have had an acute MI and who have symptoms and/or signs of heart failure and left ventricular systolic dysfunction, initiate treatment with an aldosterone antagonist licensed for post-MI treatment within 3–14 days of the MI, preferably after ACE inhibitor therapy

What was measured: Proportion of patients eligible for epleronone (an aldosterone antagonist) according to NICE guidance that were prescribed it
Data collection end: December 2014
31%
Number that met the criteria: 4 / 13
Area covered: Local
Source: Marathe MK (2015) The use of eplerenone post ST-segment elevation myocardial infarction (STEMI): Are we following the guidelines? European Journal of Cardiovascular Nursing, Conference (var.pagings): June.



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