What is it about?

Managing patients' medical risk is a core component of Cardiac Rehabilitation services in the UK. However, the medical therapy of patients following a heart attack is often suboptimal. This article evaluates the prescribing practice for patients who attended a local Cardiac Rehabilitation service following their heart attack. The service of focus included an Advanced Cardiac Rehabilitation Nurse (ACRN) with prescribing skills and qualifications. The main focus of the article is on the dose optimisation of angiotensin-converting enzyme inhibitors (ACE-I's), angiotensin II receptor antagonists (AIIRA's) and beta-blocker therapies.

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Why is it important?

The aforementioned medcations are standard therapies for all patients following a heart attack according to national guidelines, providing that there are no contraindications. These therapies have robust evidence demonstrating that they have long term cardioprotective qualities; essentially, they help people to live longer with a reduced chance of heart failure development later in life. Ensuring that the dose is up-titrated to the highest tolerated level is important for each patient, to make sure that maximum benefits are derived long term.


Advanced Cardiac Rehabilitation Nurses are well placed to review the cardioprotective medications of patients following a heart attack, although the optimiation process can be complex. Care should be taken not to overlook patients with normal heart function or mild dysfunction after a heart attack. More Advanced Practitioners are required to ensure that all patients receive a timely, thorough, medication review folowing their heart attack.

Jessica Norman
Glyndwr University

Read the Original

This page is a summary of: An evaluation of medication optimisation following myocardial infarction within a cardiac rehabilitation service, British Journal of Cardiac Nursing, May 2021, Mark Allen Group,
DOI: 10.12968/bjca.2020.0137.
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