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Question 11#

Your consultant has asked you to set up an audit of secondary prevention measures taken in your patients who have had an acute MI. 

Which one of the following would be the correct standards/targets to assess?

A. Eighty-five per cent of people discharged from hospital with a primary diagnosis of AMI or after coronary revascularization should be offered cardiac rehabilitation
B. All patients should be offered treatment with aspirin, a statin, an ACE inhibitor/ARB, a beta-blocker, and an aldosterone antagonist post-MI unless contraindicated
C. A year after discharge, at least 80% of people should be non-smokers, exercise regularly, and have a BMI <35 kg/m²
D. Following a cardiac event, patients should aim for a target blood pressure of 150/90 mmHg
E. Following a cardiac event, patients should aim to lower serum cholesterol concentrations to <5 mmol/L (LDL to <3 mmol/L)

Correct Answer is A

Comment:

The National Service Framework for Coronary Heart Disease (NSF CHD) has set the target that 85% of people discharged from hospital with a primary diagnosis of acute MI or after coronary revascularization should be offered cardiac rehabilitation, and that 1 year after discharge at least 80% of people should be non-smokers, exercise regularly, and have a BMI <30 kg/m2 . NICE and ESC guidelines recommend that post-MI patients should aim for a target BP of <140/90 mmHg and a target cholesterol of <4 mmol/L (and LDL of <2 mmol/L (<1.8 mmol/L ESC)). All patients should be offered treatment with aspirin, a statin, an ACE inhibitor/ARB, and a beta-blocker. Patients should receive dual antiplatelets12 months following an ACS irrespective of angioplasty or the type of stent. Patients with signs or symptoms of heart failure and EF <40% (EPHESUS trial) should be offered treatment with an aldosterone antagonist.