Drug Therapy for Secondary Prevention

For secondary prevention, offer people who have had MI treatment with the following drugs:

angiotensin-converting enzyme (ACE) inhibitor. Titrate the ACE inhibitor dose upwards at short intervals (for example, every 12 to 24 hours) before the person leaves hospital until the maximum tolerated or target dose is reached.

Dual antiplatelet therapy (aspirin plus a second antiplatelet) unless they have a separate indication for anticoagulation.

Beta-blocker

Consider continuing a beta-blocker for 12 months after an MI for people without reduced left ventricular ejection fraction. Discuss the potential benefits and risks of stopping or continuing beta-blockers beyond 12 months after an MI for people without reduced left ventricular ejection fraction. There is a lack of evidence on the relative benefits and harms of continuing beyond 12 months. If beta-blockers are contraindicated, verapamil or diltiazem (rate limiting calcium channel blockers) can be considered instead. Otherwise, do not routinely offer calcium channel blockers to reduce cardiovascular risk after an MI.

Statin

Ensure that a clear management plan is available to the person who has had an MI and is also sent to the GP, including:

• Details and timing of any further drug titration
• Monitoring of blood pressure
• Monitoring of renal function.