| Summary: | Objectives: Clinical trials have demonstrated that secondary prevention of myocardial infarction is effective, but several studies have suggested that research findings are not adequately implemented in routine clinical practice. This study aimed to determine whether these findings are now being more fully implemented. Methods: A cohort of 608 patients aged less than 80 years, surviving more than 28 days after an acute myocardial infarction, was identified from a population of 568,000 people in Oxfordshire, UK, during a 12-month period from November 1994. The MONICA Project diagnostic criteria for definite or possible myocardial infarction were used to define cases. Hospital and general practice casenotes were reviewed and survivors were asked to complete a questionnaire. Results: Among patients without contraindications to treatment, 430 were prescribed aspirin (97%), 277 β -blockers (66%), and 77 ACE inhibitors (85%) in the first three months after the acute event. Of these drugs, 705 (90%) were prescribed on discharge from hospital. Reliable cholesterol measurements were available for 307 patients (51%). Advice on physical activity was offered to 275 patients (45%), dietary advice to 172 (50% of patients with a total cholesterol concentration ≥ 5.5 mmol/l), and smoking cessation advice to 62 (37% of smokers). There were no differences in drug prescription rates between men and women, but women overall were significantly less likely to receive smoking cessation advice and older women, aged 60-79, were less likely to receive advice on physical activity. Conclusions:: Optimal follow-up of patients after a myocardial infarction requires a coordinated strategy between primary and secondary care. Hospital-initiated prescribing can achieve higher rates of adherence to evidence-based recommendations for drug therapy for the secondary prevention of myocardial infarction than has previously been reported. Systematic followup in general practice is needed to identify any deficiencies in hospital care, to monitor long-term therapy, and to reinforce lifestyle advice. © 1998 Informa UK Ltd All rights reserved.
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