Background/Aims Managing patients' medical risk is a core component of cardiac rehabilitation. However, the optimisation of medical therapy for patients post myocardial infarction has frequently been found to be suboptimal. This article evaluates the evidence-based prescribing practice for patients post myocardial infarction who attended a local cardiac rehabilitation service that included an advanced cardiac rehabilitation nurse. The focus is on dose optimisation of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and beta-blocker therapies. Methods Data were collected retrospectively from 100 patient records at a cardiac rehabilitation service. Explored variables included demographic factors, prescribing rates at hospital discharge, left ventricular function, drug types and doses, and drug optimisation rates and timings. Data regarding the practitioner who carried out the optimisation and any documented reasons for not pursuing further dose titration were also collected. Results The advanced cardiac rehabilitation nurse was well placed to optimise pharmacotherapy post myocardial infarction, although the optimisation process was found to be complex, often requiring an overlapping multidisciplinary team approach. Conclusions Care should be taken not to overlook patients with normal left ventricular function or mild left ventricular impairment post myocardial infarction. More advanced practitioner roles are needed to allow the team to take responsibility for the medication optimisation of all patients post myocardial infarction within the cardiac rehabilitation service. The optimisation time target set by the National Institute for Health and Care Excellence was not always reached, as it was not always feasible to safely optimise medications so quickly.
Improved post-myocardial infarction survival with probucol in rats: Effects on left ventricular function, morphology, cardiac oxidative stress and cytokine expression