Secondary prevention following myocardial infarction: evidence from an audit in South Wales that the National Service Framework for coronary heart disease does not address all the issues.

objectivesTo assess local uptake of treatments for secondary prevention of myocardial infarction and compare with targets in the National Service Framework (NSF) for coronary heart disease.

designRetrospective audit of case notes with follow up questionnaire at 1 year.

settingTeaching hospital and community.

participants100 patients alive in December 1998 who had been admitted with an acute myocardial infarction between October 1997 and October 1998.

main outcome measuresLocal use of aspirin, beta blockers, ACE inhibitors, and statins.

resultsUnless contraindicated, discharge aspirin use was 100%, beta blocker use 84%, statin prescription and/or provision of dietetic advice 66% and ACE inhibitors where any heart failure was found was 97%. 1-2 years later total cholesterol remained greater than 5.0 mmol/l in 25% of patients, 24% had stopped beta blockers, and ACE inhibitors remained at a low dose in half of those surveyed.

conclusionsThe NSF for coronary heart disease states that by April 2002 80-90% of patients should be prescribed appropriate secondary prevention. This had nearly been achieved at hospital discharge in 1999. However, follow up indicated problems in ongoing care with cholesterol targets not always being achieved, beta blockers often being stopped, and ACE inhibitors frequently remaining at low doses. Gaining maximum benefit from treatment depends on these secondary targets also being achieved. In these aspects of secondary prevention the NSF represents only an initial step towards effective prevention of coronary heart disease; perhaps the most difficult and expensive steps are yet to be fully realised.