Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7441.693 (Published 18 March 2004) Cite this as: BMJ 2004;328:693
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Dalal and co-workers have done an excellent review on recent
developments in secondary prevention and cardiac rehabilitation after
acute myocardial infarction (1). They conclude that the implementation of
these processes remains suboptimal and uses the term “implementation
gap”.
They do further discuss that implementation in primary care is perhaps not
as mechanistic as it first seems. They mention barriers such as workload
and costs.
We do really agree with the authors and would like to point out that
one way to decrease the gap and collaborate and communicate between
primary and secondary care is to use case method learning to improve
secondary prevention in coronary artery disease. We presented a randomised
controlled study on this subject in this journal in 2002 (2). This
technique is an excellent way to work interactively with the decision
making process in different contexts and contents. The general
practitioners in the intervention group were significantly more satisfied
and their patients achieved significantly lower low density lipoprotein
(LDL) cholesterol levels.
Peter Henriksson
Professor of internal medicine
Anna Kiessling
Head of the centre for clinical education
Karolinska Institute at Danderyd University hospital
SE-182 88 Stockholm
Sweden
pethen@ki.se
References
1. Dalal H, Evans PH, Campbell JL. Recent developments in secondary
prevention and cardiac rehabilitation after acute myocardial infarction.
BMJ 2004;328:693-697.
2. Kiessling A, Henriksson P. Efficacy of case method learning in
general practice for secondary prevention in patients with coronary artery
disease: randomised controlled study. BMJ 2002;325(7369):877-80.
Competing interests:
None declared
Competing interests: No competing interests
Important interventions ignored - yet again
The single most effective intervention to reduce risk of death after
myocardial infarction is adoption of a Mediterrranean diet. With advice
delivered by a a cardiologist and a nutritionist, relative risk of MI or
cardiac death is 0.28 (95% confidence interval: 0.15 to 0.53). [1] This is
equivalent to the combined effect of aspirin, a beta-blocker, an ACE
inhibitor and a statin. [2] Preliminary results of a Cochrane review
indicate that even adopting only one component of a Mediterranean diet -
increased intake of oily-fish or fish oil - substantially reduces
mortality. [3] It is the responsibility of reviewers to inform about all
important interventions. The most powerful way or ensuring an intervention
is not used is to ignore it.
REFERENCES:
1. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N.
Mediterranean Diet, Traditional Risk Factors, and the Rate of
Cardiovascular Complications After Myocardial Infarction Final Report of
the Lyon Diet Heart Study Circulation. 1999;99:779-785.
2. Yusuf S. Two decades of progress in preventing vascular disease
Lancet 2002; 360:2-3.
3. Hooper L, Ness A, Higgins JPT, Moore T, Ebrahim S. GISSI-
Prevenzione trial (correspendence) Lancet 1999; 354:1557.
Competing interests:
None declared
Competing interests: No competing interests