Background: International studies suggestal most half of all major coronary episodes annually occur in survivors of acute coronary syndrome(ACS). Objective: A greater focus on medium-and long term ACS management and adherence to proven therapies is essential if out-of-hospital reductions in mortality and morbidity are to be optimized. Methods: A national panel of clinical and research opinion leaders in ACS caremet for 2 days to set future priorities in health care delivery. Results: Lifestyle, control of risk factors, and pre- scription of pharmacological therapies can improve the course of coronary heart disease (CHD) by reduc- ing all-cause and cardiovascular mortality by 15% to 25%. All ACS patients stand to bene?t from rehabi- litation and systematic secondary prevention, how- ever, underutilization and suboptimal adherence to rehabilitation and secondary prevention measures persist globally Results: A range of new initiatives in Australia and elsewhere indicate that time is ripe for change to improve the uptake of preventative treatments in patients after ACS. Key universal drivers of delivering best evidence practice for medium- to long-term care after ACS are economics and locality. Conclusions: Health-service redesign involving all stakeholders will be integral to increasing access, up- take, and adherence to lifestyle, control of risk factors, and pharmacologic therapies shown to improve cardi- ovascular outcomes.