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MI patients should start rehab 'as soon as possible', says NICE

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Patients who have survived a first heart attack should be offered access to a cardiac rehabilitation programme as soon as possible, according to guidelines from the National Institute for Health and Care Excellence.

The National Institute for Health and Care Excellence has published updated guidance on the secondary prevention of myocardial infarction in adults in England and Wales. It replaces a version published in 2007.

The “key focus” of the new guideline is on cardiac rehabilitation programmes. NICE recommends that such programmes should begin “as soon as possible, and before the patient leaves hospital”.

Once a patient has gone home, they should be invited to a cardiac rehabilitation session that should start within 10 days of their discharge, the guidelines state.

Cardiac rehabilitation programmes should be offered in a choice of venues – including at the person’s home, in hospital and in the community – and at a choice of times of day.

In addition, NICE said programmes should provide a range of different types of exercise to meet the needs of people of all ages, or those who have other illnesses.

The guidance notes that some people, such as those from black and minority ethnic groups and those from rural communities, may be less likely to access cardiac rehabilitation programmes.

Kathryn Carver, cardiac rehabilitation lead nurse and member of the NICE guideline development group, said the national average uptake for cardiac rehabilitation in 2012 was 46%.

She said: “The recommendation that cardiac rehabilitation should be commenced prior to discharge from hospital with an early invitation to a comprehensive cardiac rehabilitation programme within 10 days of discharge will be challenging.

“However, the evidence is clear that uptake as well as completion and clinical outcomes are better if this can be achieved,” she added.

Joseph Clift, policy manager at the British Heart Foundation, said: “Cardiac rehabilitation has been identified by national government, the health service and NICE as a vital part of the care that people with heart disease should receive, yet provision and take-up remains patchy across the UK.

“In a tough financial climate for the NHS, it’s crucial to invest in effective chronic disease management that improves patients quality of life and stops their health deteriorating,” he said. “These services should be fully funded and every patient who is suitable should be offered a place on a programme.”

In another change from the original guideline, NICE no longer recommends eating oily fish, or taking omega-3 fatty acid capsules or omega-3 fatty acid supplemented foods specifically for the prevention of further heart attacks.

The guideline does, however, continue to highlight the important role of lifestyle changes in preventing further heart attacks, including that people who have had a heart attack should be encouraged to exercise for 20-30 minutes daily.

It also recommends that people who have had an MI should eat a Mediterranean-style diet and updates advice on the use of drugs, such as ACE inhibitors and beta-blockers.


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