Over the past five to ten years the management of MI has evolved dramatically throughout the spectrum of care, from acute management to longer-term secondary prevention strategies.

These developments have been supported by a solid evidence base and enshrined in numerous guidelines and protocols. The current QOF (see table 1, attached) attaches considerable importance to achieving targets in this area, and the feedback to date has suggested that primary care is doing well in achieving these targets.

A study has used data from the Global Registry of Acute Coronary Events (GRACE) to determine the changes in use of evidence-based secondary prevention strategies post-MI in secondary care over a five year period. It found an increase in the use of evidence-based therapies.

More than 26,000 patients were studied for trends in the use of aspirin, beta-blockers, ACE inhibitors, lipid-lowering agents and combinations of these drugs after admission to hospital for acute MI. The patients had no contraindications to any of the drugs and information was gathered at hospital discharge in 14 countries, including the UK, between 2000 and 2005.

The results showed that there was an increase in the use of ACE inhibitors (from 63% of patients in 2000 to 77% in 2005) and beta-blockers (83% in 2000 to 91% in 2005) during the study. There was also a marked increase in the use of lipid-lowering therapy (from 45% of patients in 2000 to 85% in 2005). Aspirin use was consistently high (around 95%) throughout the study period.

The number of patients treated with all four drugs increased from 23% in 2000 to 58% in 2005.

It is encouraging to see the increase in the use of these drugs, in particular the dramatic increase in the use of lipid-lowering therapy.

If we consider the standards in primary care that have been demonstrated in the QOF data then there is much to be applauded, but naturally ongoing efforts to improve these figures further, simplify medication regimens and ensure compliance are to be welcomed.