management post ACS in primary care

Last edited 12/2020 and last reviewed 12/2020

Assessent and Investigations:

  • attitude and psychological state. Exercise and abilities and propensities. Dietary habits and knowledge
  • smoking habits
  • blood pressure
  • full lipid profile (cholesterol will be lower than usual for 6 weeks post MI)

Management:

  • cardiac rehabilitation
  • stop smoking (record smoking status and advice)
  • dietary advice with weight control if indicated
  • control BP - treatment threshold is 140/90

A schemata has been suggested (1):

Medication Regimes: The following drug interventions work by independent mechanisms and their effects seem to be additive. All patients who have had an acute MI should be offered treatment with a combination of the following drugs (1):

  • 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

      • ensure that a clear management plan is available to the person who has had an MI and is also sent to the GP, including:
        • details and timing of any further drug titration
        • monitoring of blood pressure
        • monitoring of renal function

  • all people who have had an MI should be offered an assessment of bleeding risk at their follow-up appointment

  • all people who have had an MI should be offered an assessment of left ventricular function

Notes:

  • consider continuing a beta-blocker for 12 months after an MI for people without reduced left ventricular ejection fraction (1,2)
  • do not offer people without left ventricular systolic dysfunction or heart failure, who have had an MI more than 12 months ago, treatment with a beta-blocker unless there is an additional clinical indication for a beta-blocker (1,2)

Reference:

  1. NICE (2020). Acute coronary syndromes
  2. NICE (2013). Secondary prevention in primary and secondary care for patients following a myocardial infarction