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Background Both the incidence of myocardial infarction (MI) and short-term case fatality have declined in the UK. However, little is known about trends in longer-term survival following an MI. The aim of the study was to investigate trends in longer-term survival, alongside trends in medication prescribing in primary care. Methods Data came from 218 general practices contributing to the Health Improvement Network, a UK-wide primary care database. 3-year survival and medication use were determined for 6586 men and 3766 women who had an MI between 1991 and 2002 and had already survived 3 months. Results Adjusting for age and gender, the 3-year post- MI case-fatality rate among 3-month survivors fell by 28% (95% CI 13 to 40), from 83 deaths per 1000 person-years for MI occurring in 1991-2 to 61 deaths per 1000 person-years for MI in 2001-2. Relative declines in the case-fatality rate of 37% (20 to 50) and 14% (-11 to 34) were observed for men and women, respectively (p=0.06 for interaction). Prescribing in the 3 months following the MI of lipid-regulating drugs increased from 3% of patients in 1991 to 79% in 2002, prescribing of beta-blockers increased from 26% to 68%, prescribing of ACE inhibitors increased from 11% to 71% and prescribing of anti-platelet medication increased from 46% to 86%. Conclusion There has been a moderate improvement in longer-term survival following an MI, distinct from improvements in short-term survival, although men may have benefited more than women. Increased medication prescribing in primary care may be a contributing factor. [ABSTRACT FROM AUTHOR]

The article offers information on the clinical guidance published by the National Institute for Health and Clinical Excellence (NICE) of Great Britain in October 2010 on the early management of unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). It briefly presents the clinical definition of acute coronary syndromes, acute ST-elevation myocardial infarction (STEMI) and UA. Included in the NICE guidance are risk assessment and its impact on patient management and antiplatelet and antithrombin therapy, among others.

Objective: To assess the cost effectiveness of primary angioplasty, compared with medical management with thrombolytic drugs, to achieve reperfusion after acute myocardial infarction (AMI) from the perspective of the UK NHS. Design: Bayesian evidence synthesis and decision analytic model. Methods: A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature. Main outcome measure: Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs). Results: For the base case, the incremental cost-effectiveness ratio of primary angioplasty was £9241 for each additional QALY, with a probability of being cost effective of 0.90 for a cost-effectiveness threshold of £20 000. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty. Conclusions: Primary angioplasty is cost effective for the treatment of AMI on the basis of threshold cost- effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length. [ABSTRACT FROM AUTHOR]

Examines the prevention of ventricular arrhythmias in acute myocardial infraction in Great Britain. Effects of intravenous atenolol on ventricular arrhythmias; Application of electrocardiographic measurements; Indications of increased catecholamine concentrations in acute myocardial infarction.

Examines the effect of hyponatremia and severity on patients with myocardial infarction in Great Britain. Association between the degree of infarction and indices of severity; Influence of the duration of infarction on plasma sodium concentrations; Role of plasma sodium concentrations on sodium pump activities.

The article examines the reduction in coronary heart disease (CHD) deaths that are potentially achievable through increasing treatment levels in Great Britain. In line with the effort to increase treatment uptakes, the 2003 general medical services contract will now reward the identification of eligible patients and the creation of CHD registers. This article concludes that future national strategies should prioritize secondary prevention and heart failure.

Objective To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998-2001) and after (2003) the implementation of the national service framework. Design Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns. Participants Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001. Main outcome measures Prevalence of use of antiplatelet medication, statins, β blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003. Results Between 1998-2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins (from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received β blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments. Conclusions Between 1998-2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment (particularly with β blockers and ACE inhibitors). [ABSTRACT FROM AUTHOR]

The article focuses on a study of heart disease in male members of the Fellowship of Cycling Old Timers (FCOT) in Great Britain in 1973. Results showed that 45 members have a positive family history of heart disease. Also noted is a decline in the incidence of myocardial infarction and ischaemic heart disease in all cyclists. It points out that the number of incidence of all ischaemic heart disease is lower than expected.

Objective To compare ordinary least squares (OLS) and instrumental variable (IV) estimates of the effects of COX-2 selective inhibitor non-steroidal anti-inflammatory drugs (COX-2s) relative to non-selective NSAIDs (non-selectives) on incidence of gastrointestinal (GI) bleeding, and acute myocardial infarction (MI). We test the validity of the IV estimates, and compare to estimates from randomised controlled trials (RCTs). Design Cohort study using administration data. Setting Primary care. Participants 93 562 patients aged over 65 years attending one of 104 general practices (GP) in the UK. Main outcomes GI bleeding and acute MI. Methods We use data from the UK general practice research database. Our outcomes are incident gastrointestinal bleeding and myocardial infarctions within 60, 120, 180 and 360 days of the first prescription. We estimate risk differences in outcomes using OLS and IVs, using physician prior prescribing as an IV, and compare them to RCT estimates. Results The OLS estimates suggested COX-2s were positively associated with GI bleeds, and were negatively associated with MI. Adjusted OLS estimates were attenuated. In contrast our IV estimates imply –0.43(–1.54,0.68) fewer GI bleeds per 100 people treated with COX-2s after 180 days. The IV estimates provide little evidence, −0.55(−1.2, 1.5), of a difference in MI between treatments. These are comparable to previously published IV estimates and RCT evidence. Conclusions Deriving causal treatment effects using observational health data has proven to be problematic. We demonstrate that in contrast to IV based estimates, conventional OLS methods fail to estimate casual effects as indicated by RCTs. [ABSTRACT FROM PUBLISHER]

The article discusses a Cochrane systematic review and meta-analysis of the effectiveness of home based cardiac rehabilitation programmes and supervised centre based cardiac rehabilitation programs. The researchers considered previous knowledge on the subject, including the effectiveness of the therapeutic approaches in less than 40 percent of people who survive a heart attack in Great Britain. The article also discusses the primary outcomes of the study, potential competing interests and competing interests.

Reports on the latest guidelines for the treatment of hypertension released from the National Institute for Clinical Excellence (NICE). Recommendation that patients be given a combination of antihypertensive drugs starting with a low dose diuretic of the thiazide type before adding two other drugs; Benefits of the multiple drug treatment; Further advice for general practitioners to assess cardiovascular risk in patients with blood pressure persisting at 140/90 or higher; Which tests should be run on these patients; Recommendation of intervention on patients with a pressure of 160/100; Goal of the guidelines which is to decrease morbidity and mortality from heart attacks and stroke.

Reports that hospitals in Great Britain have shown improvements in their treatment of heart attacks. Hospitals that are missing the thrombolysis target but are moving in the right direction; Myocardial infarction national audit project that was funded by the National Institute for Clinical Excellence; Prophylaxis targets that were almost met.

This article explores the cost of care of patients with non ST elevation acute coronary syndromes in Great Britain, based on the results from the prospective registry. Patients were classified by complication after admission and cost differences were calculated. Patients admitted with acute coronary syndrome with subsequent refractory angina or new myocardial infarctions incur a substantial additional cost compared to patients without these complications. The cost of newer therapies should be assessed in relation to the benefit of preventing these complications.