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Mortality from coronary heart disease has been falling in the UK since the 1970s, but remains higher than in most other Western countries. Most patients receive some treatment for secondary prevention after myocardial infarction, but not all patients are offered the most effective secondary prevention package. The recently published NICE guideline for secondary prevention in patients after myocardial infarction, summarised in this article, makes clear recommendations for management of patients after myocardial infarction, based on best available evidence. The guidelines update the 2001 NICE guideline, and have expanded and emphasised the recommendations for physical activity, dietary and other lifestyle changes, and cardiac rehabilitation, and updated the recommendations for drug therapy. [ABSTRACT FROM AUTHOR]

The article comments on the British National Institute for Clinical Excellence's (NICE) published guideline entitled "MI: secondary prevention in primary and secondary care for patients following a myocardial infarction." It is pointed out that the guideline is essential but there is inconsistent practice regarding drug therapies. Also, other significant interventions such as advice on cardiac rehabilitation and lifestyle have not been sufficiently provided.

The article discusses the urgent need to tackle of the issue of polypharmacy according to a King's Fund report entitled "Polypharmacy and Medicines Optimisation: Making It Safe and Sound." Particular focus is given to the increase in polypharmacy which increases the risk of interactions and adverse drug reactions and affects patient compliance and quality of life. It mentions different recommendations in resolving polypharmacy problems and issues based on the King's Fund report.

Objective To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998-2001) and after (2003) the implementation of the national service framework. Design Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns. Participants Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001. Main outcome measures Prevalence of use of antiplatelet medication, statins, β blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003. Results Between 1998-2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins (from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received β blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments. Conclusions Between 1998-2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment (particularly with β blockers and ACE inhibitors). [ABSTRACT FROM AUTHOR]

Presents views of the author on articles concerning medicine-related issues published in British Medical Journal. Mortality of patients undergoing routine surgery; Stages of pulmonary hypertension; Prevention of myocardial infarction.

Discusses issues related to medicine in Great Britain. Deaths of medical practitioners; Impact of physical exercise on health; Advantages of exercise in preventing risk of having myocardial infarction.