Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Cardiac rehabilitation after an acute myocardial infarction (MI)

  • Offer cardiac rehabilitation programmes designed to motivate people to attend and complete the programme. Explain the benefits of attending. [new 2013]

  • Begin cardiac rehabilitation as soon as possible after admission and before discharge from hospital. Invite the person to a cardiac rehabilitation session which should start within 10 days of their discharge from hospital. [new 2013]

Lifestyle changes after an MI

  • Advise people to eat a Mediterranean-style diet (more bread, fruit, vegetables and fish; less meat; and replace butter and cheese with products based on plant oils). [2007]

  • Advise people to be physically active for 20–30 minutes a day to the point of slight breathlessness. Advise people who are not active to this level to increase their activity in a gradual, step-by-step way, aiming to increase their exercise capacity. They should start at a level that is comfortable, and increase the duration and intensity of activity as they gain fitness. [2007]

  • Advise all people who smoke to stop and offer assistance from a smoking cessation service in line with Brief interventions and referral for smoking cessation (NICE public health guidance 1). [2007]

Drug therapy

  • 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. [2007, amended 2013]

  • Offer an assessment of left ventricular function to all people who have had an MI. [2013]

  • Titrate the ACE inhibitor dose upwards at short intervals (for example, every 12–24 hours) before the person leaves hospital until the maximum tolerated or target dose is reached. If it is not possible to complete the titration during this time, it should be completed within 4–6 weeks of hospital discharge. [new 2013]

  • Communicate plans for titrating beta-blockers up to the maximum tolerated or target dose – for example, in the discharge summary. [new 2013]

Communication of diagnosis and advice

  • After an acute MI, ensure that the following are part of every discharge summary:

    • confirmation of the diagnosis of acute MI

    • results of investigations

    • incomplete drug titrations

    • future management plans

    • advice on secondary prevention. [2007, amended 2013]

  • National Institute for Health and Care Excellence (NICE)