NICE offers advice for secondary prevention of MI
A licensed omega-3 supplement should be considered for some patients |
All patients who have had a myocardial infarction (MI) should be offered combination treatment with an angiotensin-converting enzyme inhibitor, aspirin, a beta-blocker and a statin, new
guidance from the National Institute for Health and Clinical Excellence sets out.
Published this week by the institute, “Secondary prevention in
primary and secondary care for patients following a myocardial infarction” provides
best-practice advice based on the latest evidence, which, the institute
says, supports and updates the National Service Framework for Coronary
Heart Disease. The guideline does not cover interventions made in the
early stages of an acute MI.
NICE provides specific guidance on how best to implement the quadruple
therapy recommended in this patient group. The guideline also sets out
when it is appropriate to use warfarin, calcium channel blockers and
spironolactone.
NICE also recommends that all patients are offered a cardiological assessment
to consider whether coronary revascularisation is appropriate.
The guideline highlights the need for good communication between health
care professionals and patients, and makes clear that patients who have
had a heart attack should have the opportunity to take part in decisions
about their care.
NICE is explicit in its recommendations on the consumption of omega-3
fatty acids for this patient group. The new guideline says that patients
should be advised to consume at least 7g of omega-3 fatty acids each
week — corresponding to two to four portions of oily fish (see
Panel). NICE recommends that patients who are not achieving the suggested
amount of omega-3s in their diet should be considered for supplementation
(at least 1g of licensed omega-3-acid ethyl esters per day for up to
four years), but only if started within three months of the MI.
Lifestyle advice
On top of drug treatment recommendations, NICE has expanded its
guideline to include advice on lifestyle changes. Patients should
be advised:
• To be physically active for 20 to 30 minutes a day to the
point of breathlessness, starting at a level that is comfortable
• To quit smoking (if a smoker) and be offered assistance from
a smoking cessation service
• To eat a Mediterranean-style diet, including more bread, fruit,
vegetables and fish, and less meat |
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