Recurrent clinical events remain common among patients following an acute heart attack. Certain proteins are released from the heart when the heart is under stress; these proteins, called biomarkers, can help to identify which individuals are at higher risk of these recurrent clinical events after a heart attack. The aim of this large-scale randomised controlled trial is to assess whether a biomarker guided risk-management approach for people following a heart attack can reduce the risk of people dying or having another heart attack. The proposed study will involve more than 2000 people in 3 major regions in NZ. The study primary end point will the rate of death or hospital readmission for heart related conditions over 18 months of follow up. Healthcare processes will be assessed to ensure the results of the study can be rapidly implemented in clinical practice.