management post ACS in primary care

Last edited 12/2020 and last reviewed 04/2023

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