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;328:693Data supplement
w1 Boersma E, Mercado N, Poldermans D, Gardien M, Vos J, Simoons ML. Acute myocardial infarction. Lancet 2003;361:847-58.
w2 Department of Health. National service framework for coronary heart disease. London: Department of Health, 2000.
w3 GP Committee of the BMA, NHS Confederation. Investing in general practice: the new general medical services contract. London: British Medical Association, National Health Service Confederation, 2003.
w4 Scottish Intercollegiate Guideline Network. Secondary prevention of coronary heart disease following myocardial infarction. Edinburgh: SIGN, 2000. (SIGN guideline 41.)
w5 National Institute for Clinical Excellence. Prophylaxis for patients who have experienced a myocardial infarction. London: NICE, 2001. (Clinical guideline A.)
w6 Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001;345:494-502.
w7 White HD. Should all patients with coronary disease receive angiotensin-converting enzyme inhibitors? Lancet 2003;362:755-7.
w8 Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet 2002;360:752-60.
w9 Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893-906.
w10 Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4S). Lancet 1994;344:1383-9.
w11 British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, endorsed by the British Diabetic Association. Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998;80(suppl 2):S1-29.
w12 DeWilde S, Carey IM, Bremner SA, Richards N, Hilton SR, Cook DG. Evolution of statin prescribing 1994-2001: a case of agism but not of sexism? Heart 2003;89:417-21.
w13 Chin-Dusting JP, Dart AM. Age and the treatment gap in the use of statins. Lancet 2003;361:1925-6.
w14 Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for reversible airway disease. Cochrane Database Syst Rev 2002;(4):CD002992.
w15 Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998;339:489-97.
w16 Heintzen MP, Strauer BE. Peripheral vascular effects of beta-blockers. Eur Heart J 1994;15(suppl C):2-7.
w17 Burns P, Gough S, Bradbury AW. Management of peripheral arterial disease in primary care. BMJ 2003;326:584-8.
w18 Begg A. Tackling the clinical indicators: secondary prevention of CHD. Guidelines in Practice 2003;9:45-51.
w19 Murchie P, Campbell NC, Ritchie LD, Simpson JA, Thain J. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care. BMJ 2003;326:84.
w20 Campbell NC, Ritchie LD, Thain J, Deans HG, Rawles JM, Squair JL. Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care. Heart 1998;80:447-52.
w21 Cupples ME, McKnight A. Five year follow up of patients at high cardiovascular risk who took part in randomised controlled trial of health promotion. BMJ 1999;319:687-8.
w22 Jolly K, Bradley F, Sharp S, Smith H, Thompson S, Kinmonth AL, et al. Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP). BMJ 1999;318:706-11.
w23 Feder G, Griffiths C, Eldridge S, Spence M. Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): randomised controlled trial. BMJ 1999;318:1522-6.
w24 McAlister FA, Lawson FM, Teo KK, Armstrong PW. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. BMJ 2001;323:957-62.
w25 Jolliffe JA., Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001;(1):CD001800.
w26 Brown A, Taylor R, Noorani H, Stone J, Skidmore B. Exercise-based cardiac rehabilitation programs for coronary artery disease: a systematic clinical and economic review. Ottawa: Canadian Coordinating Office for Health Technology Assessment, 2003.
w27 Scottish Intercollegiate Guidelines Network. Cardiac rehabilitation: a national clinical guideline. Edinburgh: SIGN, 2002. (SIGN publication no 57.)
w28 Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA, et al. Cardiac rehabilitation as secondary prevention. Clin Pract Guidel Quick Ref Guide Clin 1995;17:1-23.
w29 Gordon NF, English CD, Contractor AS, Salmon RD, Leighton RF, Franklin BA, et al. Effectiveness of three models for comprehensive cardiovascular disease risk reduction. Am J Cardiol 2002;89:1263-8.
w30 Bethell HJ, Mullee MA. A controlled trial of community based coronary rehabilitation. Br Heart J 1990;64:370-5.
w31 Williams MA, Fleg JL, Ades PA, Chaitman BR, Miller NH, Mohiuddin SM, et al. Secondary prevention of coronary heart disease in the elderly (with emphasis on patients > or =75 years of age): an American Heart Association scientific statement from the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 2002;105:1735-43.
w32 Joseph AM, Norman SM, Ferry LH, Prochazka AV, Westman EC, Steele BG, et al. The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med 1996;335:1792-8.
w33 Schleifer SJ, Macari-Hinson MM, Coyle DA, Slater WR, Kahn M, Gorlin R, et al. The nature and course of depression following myocardial infarction. Arch Intern Med 1989;149:1785-9.
w34 Hobbs FD, Erhardt L. Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the reassessing European attitudes about cardiovascular treatment (REACT) survey. Fam Pract 2002;19:596-604.
w35 Office for National Statistics Mortality Statistics. Health statistics quarterly 18, Summer 2003. London: Office for National Statistics, 2003. (www.statistics.gov.uk)
w36 Leatherman S, Sutherland K. Quest for quality in the NHS. London: Nuffield Trust, 2003.
w37 Freeman AC, Sweeney K. Why general practitioners do not implement evidence: qualitative study. BMJ 2001;323:1100-2.
w38 Kedward J, Dakin L. A qualitative study of barriers to the use of statins and the implementation of coronary heart disease prevention in primary care. Br J Gen Pract 2003;53:684-9.
w39 Hippisley-Cox J, Pringle M. General practice workload implications of the national service framework for coronary heart disease: cross sectional survey. BMJ 2001;323:269-70.
I used to be a clinical physiologist, specialising in cardiovascular medicine. I gave it all up to work in the television industry. I now work as a freelance lighting cameraman, and I teach technical TV studies at Falmouth College of Arts in Cornwall.
Last October (2002) I had just begun my lecture on camera operation when I was aware of epigastric discomfort. I became rather hot and breathless and noticed my left arm beginning to ache. I felt so bad that I had to excuse myself from the class and go and have a cup of coffee and a lie down. I felt better and self diagnosed flu, as it was around at the time.
I drove home to Newquay (25 miles). After explaining the symptoms to my partner and stating that, "If I didn’t know better, I would have thought that I was having an infarct," I went to bed for the afternoon. In the evening, we went to our Buddhist meditation group. I felt fine. At 2 am I awoke to go to the toilet and noticed a resurgence of the epigastric discomfort and aching left arm. I still wasn’t convinced, so I tried various indigestion remedies we had. An hour later I thought I’d ring NHS Direct for a second opinion. I was told, rather firmly, to stay on the phone and that an ambulance would be there in five minutes. I stated that I could drive myself to A&E, but they were very insistent.
Deep down I had my suspicions, which were confirmed by the 12 lead electrocardiogram in the ambulance. When I saw the electrocardiogram I felt relieved, as it was an inferior myocardial infarction but a classic appearance. In the ambulance I was given aspirin, oxygen, glyceryl trinitrate, and a Venflon. What no tPA? Cornish paramedics aren’t trained to give it as yet, but one day, who knows? I felt calm as I thought it was a bit of an adventure. (Nothing much happens in Cornwall.) The paramedic commented on this calmness. I said "I am a Buddhist you know."
When we got to A&E at the Royal Cornwall Hospital, Truro, I had a conformation 12 lead and was dispatched straight to the coronary care unit. There I was given a heparin infusion, tenecteplase and diamorphine. After being clerked in, I was left to enjoy the diamorphine and slept till morning. The electrocardiogram reverted within an hour of admission, and I had an uneventful recovery. Five days later, and after doing six minutes on the treadmill, I was discharged.
I have had no anginal symptoms since, but subsequent treadmill tests demonstrated ST segment depression in the inferior leads at 9-12 minutes. I am waiting for an angioplasty but understand there is a 12 month waiting list. I have already gone off the idea.
The back-up from cardiac rehabilitation was reassuring, and I drew the manual rather than the classes. This suited me better. The relaxation and frequently asked questions tapes were very good, and the book gave useful information and an exercise regimen.
My risk factors? Hypertension, hypercholesterolaemia (6.3), and hypothyroidism. I am a vegetarian, teetotal active swimmer, meditator, and cyclist, very aware of my health and fitness.
Related articles
- This Week In The BMJ Published: 18 March 2004; BMJ 328 doi:10.1136/bmj.328.7441.0-e
- Correction Published: 15 April 2004; BMJ 328 doi:10.1136/bmj.328.7445.926-a
- Letter Published: 25 November 2015; BMJ 351 doi:10.1136/bmj.h6350
See more
- Sixty seconds on . . . 10 000 stepsBMJ March 08, 2024, 384 q598; DOI: https://doi.org/10.1136/bmj.q598
- Scarlett McNally: Enabling active travel can improve the UK’s healthBMJ March 06, 2024, 384 q522; DOI: https://doi.org/10.1136/bmj.q522
- Scarlett McNally: Boosting swimming for health and joyBMJ February 20, 2024, 384 q393; DOI: https://doi.org/10.1136/bmj.q393
- Variability in blood pressure could help predict heart attack and stroke risk, researchers sayBMJ February 09, 2024, 384 q363; DOI: https://doi.org/10.1136/bmj.q363
- Scarlett McNally: Preventing obesity is different from curing it—and even more urgentBMJ January 23, 2024, 384 q134; DOI: https://doi.org/10.1136/bmj.q134
Cited by...
- Acute coronary syndromes: key role of rehabilitation and primary care in long term secondary prevention
- Cardiac rehabilitation
- ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Neurology; American Association of Cardiovascular and Pulmonary Rehabilitation; American College of Preventive Medicine; American College of Sports Medicine; American Diabetes Association; American Society of Hypertension; Association of Black Cardiologists; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute; National Lipid Association; and Preventive Cardiovascular Nurses Association
- ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease
- Intake of Fish Oil, Oleic Acid, Folic Acid, and Vitamins B-6 and E for 1 Year Decreases Plasma C-Reactive Protein and Reduces Coronary Heart Disease Risk Factors in Male Patients in a Cardiac Rehabilitation Program
- Cardiac Rehabilitation and Survival of Dialysis Patients after Coronary Bypass
- ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)
- ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)