National Institute for Health and Clinical Excellence (NICE)
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Offer cardiac rehabilitation "as soon as possible" to heart attack patients

Cardiac rehabilitation should be offered as soon as possible to people who have had a myocardial infarction (MI) to help them get back to everyday life as quickly as possible, says NICE.

Consisting of a programme of exercise, education and psychological support, cardiac rehabilitation can help people recover from a heart attack, make lifestyle changes to improve heart health and quality of life, and reduce the risk of a future attack.

In England and Wales in 2011/12 more than 79,000 hospital admissions were caused by MI.

However, just 46 per cent of patients were started on an outpatient cardiac rehabilitation programme following an MI.

People also had to wait an average of 53 days to start an outpatient rehabilitation programme.

In an update to the 2007 guideline on the secondary prevention of MI, NICE stresses the importance of offering cardiac rehabilitation programmes to people who have had an MI and starting the programme within 10 days of their discharge from hospital.

Rehabilitation programmes should be designed to motivate people to attend and complete the programme, and healthcare professionals should explain the benefits of attending and discuss any factors that hamper attendance at a cardiac rehabilitation programme, such as transport difficulties.

In order to further boost uptake levels, NICE recommends that cardiac rehabilitation programmes should take place in a choice of venues, including the person's home, and at a choice of times of day.

Single-sex cardiac rehabilitation programme classes should also be offered to help increase uptake, if there is sufficient demand for them.

Elsewhere, there are new recommendations covering drug treatment.

NICE now recommends that healthcare professionals do not offer combined treatment with an ACE inhibitor and an angiotensin II receptor blocker (ARB) to people after an MI, unless there are other reasons to use this combination.

Offer people after an MI who are intolerant to ACE inhibitors, an ARB instead of an ACE inhibitor.

Clopidogrel with warfarin should be offered to people with a sensitivity to aspirin who otherwise need anticoagulation and aspirin and who have had an MI, says NICE.

But do not routinely offer warfarin in combination with prasugrel or ticagrelor to people who need anticoagulation who have had an MI, the guidance adds.

The updated guidance 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, as new evidence has suggested that any impact an oily fish diet may have on preventing further heart attacks or strokes could be minimal.

Dr Phil Adams, a retired consultant cardiologist and Chair of the Guideline Development Group, said: "The guideline stresses the importance of starting cardiac rehabilitation very early so that people can straight away start to learn about the lifestyle changes that will help, for instance stopping smoking, and can make plans for exercise when they are ready.”

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Despite the improvements in the number of people surviving a heart attack, heart disease remains the UK's biggest killer. It also causes ongoing health problems for many thousands of others.

"This updated guideline takes on board the latest evidence on the best ways to prevent further heart attacks or strokes in people who have already suffered a heart attack. Its aim is to ensure the growing number of people who now survive a heart attack are provided with the good quality, systematic care that is essential to improving long term outcomes and quality of life.”

A NICE commissioning guide is available to help commission cardiac rehabilitation services.

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