This guideline covers cardiac rehabilitation and preventing further cardiovascular disease in people aged 18 and over who have had a myocardial infarction. It aims to promote the health of people who have had an MI by encouraging them to attend a cardiac rehabilitation programme and advising them on a healthy lifestyle. It also includes advice on drug therapy.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners
  • Adults who have had a myocardial infarction, and their families and carers

Is this guideline up to date?

We reviewed the evidence in May 2017 and we are updating the recommendations on beta-blocker treatment in patients without left ventricular dysfunction after MI.

We will also withdraw the recommendations about antiplatelet therapy for people without an indication for anticoagulation. The NICE guideline on unstable angina and NSTEMI: early management published in 2010, is currently undergoing update and a cross-referral to this guideline will be made after publication. See the surveillance report for further details on this update.

We will also withdraw the recommendation relating to alcohol consumption and replace it with a cross referral to the most recent guidance from the Department of Health on how to keep health risks from drinking alcohol to a low level.

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces NICE guideline CG48 (May 2007). It also updates recommendation 1.3 in NICE technology appraisal guidance 80 (July 2004).

This guideline was previously called acute heart failure: diagnosing and managing acute heart failure in adults.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)