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Objective: There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO.Methods: Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences.Results: In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28-0.88, p=0.016).Conclusions: Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) presents a significant burden to the UK. This review presents data from nationally representative datasets to provide up-to-date statistics on mortality, prevalence, treatment and costs. Data focus on CVD as a whole, coronary heart disease (International Classification of Diseases (ICD):I20-25) and cerebrovascular disease (ICD:I60-69); however, where available, other cardiovascular conditions are also presented. In 2012, CVD was the most common cause of death in the UK for women (28% of all female deaths), but not for men, where cancer is now the most common cause of death (32% of all male deaths). Mortality from CVD varies widely throughout the UK, with the highest age-standardised CVD death rates in Scotland (347/100 000) and the North of England (320/ 100 000 in the North West). Prevalence of coronary heart disease is also highest in the North of England (4.5% in the North East) and Scotland (4.3%). Overall, around three times as many men have had a myocardial infarction compared with women. Treatment for CVD is increasing over time, with prescriptions and operations for CVD having substantially increased over the last two decades. The National Health Service in England spent around £6.8 billion on CVD in 2012/2013, the majority of which came from spending on secondary care. Despite significant declines in mortality in the UK, CVD remains a considerable burden, both in terms of health and costs. Both primary and secondary prevention measures are necessary to reduce both the burden of CVD and inequalities in CVD mortality and prevalence. [ABSTRACT FROM AUTHOR]

Background: Standardised mortality ratios (SMR) are often used to depict cardiovascular care. Data missingness, data quality, temporal variation and casemix can, however, complicate the assessment of clinical performance. Objectives: To study Primary Care Trust (PCT) 30-day SMRs for STEMI and NSTEMI whilst considering the impact of missing data for age, sex and IMD score. Design Observational study using data from the Myocardial Ischaemia National Audit Project (MINAP) database to generate PCT SMR maps and funnel plots for England, 2004e2007. Patients: 217,157 patients: 40.4% STEMI and 59.6% NSTEMI. Results: 95% CI 30-day unadjusted mortality: STEMI 5.8% to 6.2%; NSTEMI 6.6% to 6.9%; relative risk, 95% CI 1.14, 1.10 to 1.19. Median (IQR) data missingess by PCT for composite of age, sex and IMD score was 1.4% (0.7% to 2.2%). For STEMI and NSTEMI statistically significant predictors of mortality were mean age (STEMI: P<0.001; NSTEMI: P<0.001), proportion of females (STEMI: P<0.001; NSTEMI: P<0.001) and proportion of missing ages (STEMI: P=0.02; NSTEMI: P<0.001). Proportion of missing sex also predicted 30-day mortality for NSTEMI (P¼0.01). Maps of SMRs demonstrated substantial mortality variation, but no evidence of North / South divide. There were significant correlations between STEMI and NSTEMI observed (R2 0.72) and standardised mortality (R2 0.49) rates. PCT data aggregation gave an acceptable model fit in terms of deviance explained. For STEMI there were 33 (21.7%) regions below the 99.8% lower limit of the associated performance funnel plot, and 28 (18.4%) for NSTEMI; the inclusion of missing data did not affect the distribution of SMRs. Conclusions: The proportion of missing data was associated with 30-day mortality for STEMI and NSTEMI, however it did not influence the distribution of PCTs within the funnel plots. There was considerable variation in mortality not attributable to key patient-specific factors, supporting the notion of regional-dependent variation in STEMI and NSTEMI care. [ABSTRACT FROM AUTHOR]

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]

Objective To evaluate the performance of ASSIGN against the Framingham equations for predicting 10 year risk of cardiovascular disease in a UK cohort of patients from general practice and to make the evaluation comparable to an independent evaluation of QRISK on the same cohort. Design Prospective open cohort study. Setting 288 practices from England and Wales contributing to The Health Improvement Network (THIN) database. Participants Patients registered with 288 UK practices for some period between January 1995 and March 2006. The number of records available was 1 787 169. Main outcome measures First diagnosis of myocardial infarction, coronary heart disease, stroke and transient ischaemic attacks recorded. Methods We implemented the Anderson Framingham Coronary Heart Disease and Stroke models, ASSIGN, and a more recent Framingham Cox proportional-hazards model and analysed their calibration and discrimination. Results Calibration showed that all models tested overestimated risk particularly for men. ASSIGN showed better discrimination with higher AUROC (0.756/0.792 for men/women), D statistic (1.35/1.58 for men/ women), and R2 (30.47%/37.39% for men/women). The performance of ASSIGN was comparable to that of QRISK on the same cohort. Models agreed on 93e97% of categorical (high/lower) risk assessments and when they disagreed, ASSIGN was often closer to the estimated Kaplan-Meier incidence. ASSIGN also provided a steeper gradient of deprivation and discriminated between those with and without recorded family history of CVD. The estimated incidence was twice/three times as high for women/men with a recorded family history of CVD. Conclusions For systematic CVD risk assessment all models could usefully be applied, but ASSIGN improved on the gradient of deprivation and accounted for recorded family history whereas the Framingham equations did not. However, all models display relatively low specificity and sensitivity. An additional conclusion is that the recording of family history of CVD in primary care databases needs to improve given its importance in risk assessment. [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.

Objectives To examine whether second-hand smoke (SHS) exposure measured by serum cotinine is associated with increased coronary heart disease (CHD) and stroke risk among contemporary older British adults. Design Prospective population-based study with self-reported medical history and health behaviours. Fasting blood samples were analysed for serum cotinine and cardiovascular disease (CVD) risk markers. Setting Primary care centres in 25 British towns in 1998-2001. Patients 8512 60-79-year-old men and women selected from primary care registers. Main outcome measures Fatal and non-fatal myocardial infarction (MI; n=445) and stroke (n=386) during median 7.8-year follow-up. Main exposure Observational study of serum cotinine assayed from fasting blood sample using liquid chromatography tandem mass spectrometry method, and self-reported smoking history. Results Among 5374 non-smokers without pre-existing CVD, geometric mean cotinine was 0.15 ng/ml (IQR 0.05-0.30). Compared with non-smokers with cotinine ≤ =0.05 ng/ml, higher cotinine levels (0.06-0.19, 0.2-0.7 and 0.71-15.0 ng/ml) showed little association with MI; adjusted HRs were 0.92 (95% CI 0.63 to 1.35), 1.07 (0.73 to 1.55) and 1.09 (0.69 to 1.72), p(trend)=0.69. Equivalent HRs for stroke were 0.82 (0.55 to 1.23), 0.74 (0.48 to 1.13) and 0.69 (0.41 to 1.17), p(trend)=0.065. The adjustment for sociodemographic, behavioural and CVD risk factors had little effect on the results. The HR of MI for smokers (1-9 cigarettes/day) compared with non-smokers with cotinine ≤ =0.05 ng/ml was 2.14 (1.39 to 3.52) and 1.03 (0.52 to 2.04) for stroke. Conclusions In contemporary older men and women, SHS exposure (predominantly at low levels) was not related to CHD or stroke risks, but we cannot rule out the possibility of modest effects at higher exposure levels. [ABSTRACT FROM AUTHOR]

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]

Background: The EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) trial has recently reported. Objective: To assess the cost effectiveness of perindopril in stable coronary heart disease in the UK. Methods: Clinical and resource use data were taken from the EUROPA trial. Costs included drugs and hospitalisations. Health-related quality of life values were taken from published sources. A cost-effectiveness analysis is presented as a function of the risk of a primary event (non-fatal myocardial infarction, cardiac arrest or cardiovascular death) in order to identify people for whom treatment offers greatest value for money. Results: The median incremental cost of perindopril for each quality-adjusted life year (QALY) gained across the heterogeneous population of EUROPA was estimated as £9700 (interquartile range £6400-£14 200). Overall, 88% of the EUROPA population had an estimated cost per QALY below £20 000 and 97% below £30 000. For a threshold value of cost effectiveness of £30 000 per QALY gained, treatment of people representing the 25th, 50th (median) and 75th centiles of the cost effectiveness distribution for perindopril has a probability of 0.999, 0.99 and 0.93 of being cost effective, respectively. Cost effectiveness was strongly related to higher risk of a primary event under standard care. Conclusions: Whether the use of perindopril can be considered cost effective depends on the threshold value of cost effectiveness of healthcare systems. For the large majority of patients included in EUROPA, the incremental cost per QALY gained was lower than the apparent threshold used by the National Institute for Health and Clinical Excellence in the UK. [ABSTRACT FROM AUTHOR]

The British Cardiac Society commissioned this report to help address inconsistencies in the terminology for acute coronary syndromes and wide variations in the threshold for the diagnosis of myocardial infarction (MI) depending on the assay performed, the precision, and the sensitivity. In addition, several publications have highlighted potential problems with the application of the European Society of Cardiology(ESC)/American College of Cardiology (ACC) consensus document published in 2000. A revision process has been initiated under the guidance of the ESC, the ACC, and the American Heart Association (AHA). The purpose of this report is to help inform the next revision of the ESC/ ACC/AHA guidelines for the diagnosis of MI. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To examine hospital admissions for a range of diagnoses on days surrounding England's 1998 World Cup football matches. Design: Analysis of hospital admissions obtained from English hospital episode statistics. Setting: England. Participants: Population aged 15-64 years. Main outcome measures: Ratio of number of admissions for acute myocardial infarction, stroke, deliberate self harm, and road traffic injuries on the day of and five days after England's World Cup matches, compared with admissions at the same time in previous and following years and in the month preceding the tournament. Results: Risk of admission for acute myocardial infarction increased by 25% on 30 June 1998 (the day England lost to Argentina in a penalty shoot-out) and the following two days. No excess admissions occurred for other diagnoses or on the days of the other England matches. The effect was the same when only the two days after the match were treated as the exposed condition. Individual analyses of the day of and the two days after the Argentina match showed 55 extra admissions for myocardial infarctions compared with the number expected. Conclusion: The increase in admissions suggests that myocardial infarction can be triggered by emotional upset, such as watching your football team lose an important match. [ABSTRACT FROM AUTHOR]

Abstract Problem: Delay in starting thrombolytic treatment in patients arriving at hospital with chest pain who are diagnosed as having acute myocardial infarction. Design: Audit of "door to needle times" for patients presenting with chest pain and an electrocardiogram on admission that confirmed acute myocardial infarction. A one year period in each of three phases of development was studied. Background and setting: The goal of the national service framework for coronary heart disease is that by April 2002, 75% of eligible patients should receive thrombolysis within 30 minutes of arriving at hospital. A district general hospital introduced a strategy to improve door to needle times. In phase 1 (1989-95), patients with suspected acute myocardial infarction, referred by general practitioners, were assessed in the coronary care unit; all other patients were seen first in the accident and emergency department. In phase 2 (1995-7), all patients with suspected acute myocardial infarction were transferred directly to a fast track area within the coronary care unit, where nurses assess patients and doctors started treatment. Key measures for improvement: Median door to needle time in phase 1 of 45 minutes (range 5-300 minutes), with 38% of patients treated within 30 minutes. Median door to needle time in phase 2 of 40 minutes (range 5-180 minutes), with 47% treated within 30 minutes Strategies for change: In phase 3 (1997-2001), all patients with suspected acute myocardial infarction were transferred directly to the fast track area and assessed by a "coronary care thrombolysis nurse." If electrocardiography confirmed the diagnosis of acute myocardial infarction, the nurse could initiate thrombolytic therapy (subject to guidelines and exclusions determined by the consultant cardiologists). Effects of change: Median door to needle time in phase 3 of 15 minutes (range 5-70 minutes), with 80% of patients treated within 30 minutes. Systematic clinical review showed no... [ABSTRACT FROM AUTHOR]

Objective: To assess whether long term trends over time in acute coronary heart disease (CHD) event rates have influenced the burden of prevalent CHD in British men.Design: Longitudinal cohort study.Participants: 7735 men, aged 40-59 at entry (1978-80), selected from 24 British towns.Methods: The prevalences of current angina symptoms and history of diagnosed CHD were ascertained by questionnaire in 1978-80, 1983-85, 1992, and 1996. New major CHD events (fatal and non-fatal) were ascertained throughout the study from National Health Service central registers and general practice record reviews. Age adjusted trends in CHD prevalence were compared with trends in major CHD event rates.Results: From 1978-1996 there was a clear decline in the prevalence of current angina symptoms: the age adjusted annual percentage change in odds was -1.8% (95% confidence interval (CI) -2.8% to -0.8%). However, there was no evidence of a trend in the prevalence of history of diagnosed CHD (annual change in odds 0.1%, 95% CI -1.0% to 1.2%). Over the same period, the CHD mortality rate fell substantially (annual change -4.1%, 95% CI -6.5% to -1.6%); rates of non-fatal myocardial infarction, all major CHD events, and first major CHD event fell by -1.7% (95% CI -3.9% to 0.5%), -2.5% (95% CI -4.1% to -0.8%), and -2.4% (95% CI% -4.3 to -0.4%), respectively.Conclusions: These results suggest that middle aged British men are less likely to experience symptoms of angina than in previous decades but are just as likely to have a history of diagnosed CHD. Despite falling rates of new major events and falling symptom prevalence, the need for secondary prevention among middle aged men with established CHD is as great as ever. [ABSTRACT FROM AUTHOR]

Provides information on the practice of using thrombolytic treatment in the United Kingdom (UK) on patients who have had acute myocardial infarction. Clinical practice in the UK; How successful the practice in thrombolytic drugs been; Overview of research aimed at improving outcome in patients with acute myocardial infarction.

Examines the incidence of arrhythmias in patients with suspected myocardial infarction in Great Britain. Effect of beta-blockers on arrhythmias; Use of electrocardiographic tape -recorder in examining the incidence; Assessment on the drugs intended to reduce mortality from 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.

Discusses the psychological rehabilitation of patients after myocardial infarction in Great Britain. Role of nurse counsellor in the rehabilition of patients; Difficulty in achieving psychological adjustments; Value of the psychological aspects of rehabilitation.

Examines the use of streptokinase in acute myocardial infarction in Great Britain. Dissociation between mortality and site of infarction; Incidence of cardiac failure and reinfraction; Thromboembolic complications associated with the thrombolytic action of streptokinase.

Focuses on medical-related issues in Great Britain. Use of human immunoglobulin in the prevention of tetanus; Responsibility of neurosurgeons for the treatment of patients with head injuries; Influence of vitamins D and A on the incidence of myocardial infarction.

Examines the myocardial infarction in young women with special reference to oral contraceptive practice in the Great Britain. Discharge of 63 women suffering from myocardial infarction from hospitals; Relationship between myocardial infarction and oral contraceptives; Presentation on the incidence of myocardial infarction.

Evaluates the oral contraceptives and death from myocardial infarction in the Great Britain. Investigation of 219 deaths from myocardial infraction in women under the age of 50; Examination on the frequency of usage of oral contraceptives; Risk of fatal myocardial infarction in women using oral contraceptives.

Examines the pattern of risk factors for acute myocardial infarction associated with oral contraception study of women in the Royal College of General Practitioners in London, England. Relationship between the social class and the risks of patients; Implications of the illness on other diseases; Distinction of smoking as predictor of the disease.

Compares the long term outcome after first myocardial infarction among British patients originating from the Indian subcontinent and from Europe. Risk of mortality; Risk for further coronary events; Prevalence of diffuse coronary atheroma; Coronary revascularization.

Examines the mortality rate in patients with suspected acute myocardial infarction in Great Britain. Factors attributing to mortality; Identification of hazard ratio for acute myocardial infarction using stratified cox analysis; Cardiac causes of death.

Reports developments in health services in Great Britain. Guidelines for early management of myocardial infarction; Training in the basic life support for the families of patients with heart; Need for change in the management of myocardial infarction.

Presents guidelines for the early management of patients with myocardial infarction in Great Britain. Responsibilities of general practitioners in treating myocardial patients; Importance of rapid provision of basic and advanced life support to patients; Display of the principles of managing patients. INSET: Principles of management.

Investigates the effect of high and low intensity exercise in the quality of life after acute myocardial infarction in Great Britain. Bases for physical working capacity of the subjects; Assessment of occupational adjustments; Absence of effects of treatment and time point.

Examines the relationship between physical activity and stroke among middle aged men in Great Britain. Association of physical activity associated with factors relating to stroke; Essence of sporting activity to the reduction of heart attack; Classification of physical activities.

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.

Part I, II and III. Focuses on the use of a beta-blocker in survivor of heart attack in Great Britain. Difficulty to use beta-blockers in the initial stages of a heart attack; Reduction of mortality in patients treated with beta-blockers; Administration of beta-blockers in patients due to hypertension or angina.

Examines the result of the experiment in patient education with myocardial infarction in Great Britain. Diagnosis of myocardial infarction; Effect of heartwatch on time of call; Symptoms of myocardial infarction.

Comments on several medical issues in Great Britain. Fear on myocardial infarction; Audit of a surgical firm using the microcomputer; Random trial of prophylactic daily aspirin in male doctors; Use of varicella vaccine; Dietary management of gastroenteritis.

Presents several letters related to medicine in Great Britain. Clarification of the definition of the job of general physicians and medical specialists; Identification of men with high heart attack risks; Examination of morphine intoxication in renal failure.

Focuses on the use of a strategic devised in identifying men at high risk of acute myocardial infarction in Great Britain. Risk factors of ischemic heart disease; Assessment on combined effect of several risk factors; Profile of men at risk.

Investigates the controversies in the coronary care in Great Britain. Ineffectivity of coronary care in reducing mortality from myocardial infarction; Studies sponsored by the Department of Health and Social Security on home and hospital treatments of myocardial infarction; Benefits of mobile coronary care units.

The article comments on the British National Institute for Clinical Excellence's (NICE) published guideline entitled "MI: secondary prevention in primary and secondary care for patients following a myocardial infarction." It is pointed out that the guideline is essential but there is inconsistent practice regarding drug therapies. Also, other significant interventions such as advice on cardiac rehabilitation and lifestyle have not been sufficiently provided.

Mortality from coronary heart disease has been falling in the UK since the 1970s, but remains higher than in most other Western countries. Most patients receive some treatment for secondary prevention after myocardial infarction, but not all patients are offered the most effective secondary prevention package. The recently published NICE guideline for secondary prevention in patients after myocardial infarction, summarised in this article, makes clear recommendations for management of patients after myocardial infarction, based on best available evidence. The guidelines update the 2001 NICE guideline, and have expanded and emphasised the recommendations for physical activity, dietary and other lifestyle changes, and cardiac rehabilitation, and updated the recommendations for drug therapy. [ABSTRACT FROM AUTHOR]

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.

Despite the clinical benefits and safety profile of primary percutaneous coronary intervention (PCI), the health care system in the UK has been slow to adopt this strategy as first line management for ST segment elevation myocardial infarction. The cost implications of a 24 hour a day, seven days per week primary PCI service and the absence of an existing efficient working model within the National Health Service (NHS) framework are two of the major deterrents for provision of such a service. The existent cost effectiveness data for primary PCI is critically reviewed, with particular reference to the NHS. [ABSTRACT FROM AUTHOR]

The National Service Framework (NSF) established coronary heart disease as a priority area for the government and for the National Health Service (NHS). In the three and a half years since its launch, good progress has been made and the NSF is already delivering real improvements for patients, demonstrated by a near 25% reduction in the death rate from circulatory diseases. Prescribing of cardiovascular drugs for secondary prevention has increased, acute myocardial infarction is being treated more promptly, and there is improved access to revascularization procedures. However, there is still a notable class differential in cardiovascular deaths. There has been exponential growth in use of statins but the drugs are still not being used to optimum effect. Heart failure has now been identified as a priority for action. [ABSTRACT FROM AUTHOR]

The Myocardial Infarction National Audit Project (MINAP) was developed primarily as a response by the profession to the audit requirements of the National Service Framework for coronary heart disease. MINAP began to collect data in October 2000 and by October 2002, 223 hospitals in England and Wales had returned data on patients with acute myocardial infarction. MINAP provides contemporary analyses of hospital performance, with the ability to compare local performance against the national aggregate. In the third quarter of 2002, 67% of patients received thrombolytic treatment within 30 minutes of hospital arrival. At the same time only 37% of patients received treatment within 60 minutes of calling for help, and only about 20% reached hospital within 30 minutes of calling for help. In order to improve speed of access to thrombolytic treatment there is a need for increased use of pre-hospital treatment. [ABSTRACT FROM AUTHOR]

Compares the survival of patients with heart attacks admitted to a coronary care unit (CCU) and an ordinary medical ward in Great Britain. Reason behind the medical ward admission of some patients; Difference on resuscitation achievements between patients in CCU and patients in medical ward; Comparison on the mortality of the patients.

The article discusses the urgent need to tackle of the issue of polypharmacy according to a King's Fund report entitled "Polypharmacy and Medicines Optimisation: Making It Safe and Sound." Particular focus is given to the increase in polypharmacy which increases the risk of interactions and adverse drug reactions and affects patient compliance and quality of life. It mentions different recommendations in resolving polypharmacy problems and issues based on the King's Fund report.

The article focuses on whether cardiac rehabilitation (CR) would fit for purpose in Great Britain National Health Service. Scientific evidences show that the effect of cardiac rehabilitation is strong with 13 percent and 26 percent reductions in total mortality and cardiac mortality respectively. According to the results of rehabilitation after myocardial infarction trial, there were no differences in the possible outcomes of CR when compared to other routine medical care methods.

The authors consider the findings of randomized controlled trials on the benefits of dabigatran etexilate, an oral prodrug, in patients with atrial fibrillation. The prevalence of atrial fibrillation in Great Britain is briefly cited. Particular reference is given to the 2009 Randomized Evaluation of Long Term Anticoagulation Therapy (RE-LY) trial. Identified side effects of dabigatran etexilate at increased dosage included gastrointestinal bleeding and myocardial infarction. The authors argue that the question of safety and efficacy is still unanswered.

The article presents an obituary for Brian Anthony Wolfenden, Preston general practitioner, who died on August 14, 2015.

In this article the author discusses patients in Great Britain who, as a result of policy changes, are delaying health care and potentially putting themselves at risk of serious health consequences. Results of a study by Lasserson and colleagues, and studies from the U.S. and Australia, support these findings. Studies from the U.S. suggest that women were more likely to see a specialists during an acute illness. A Canadian study suggests that people have a greater propensity to seek emergency care if their doctor had instructed them to ahead of time. Educating patients about seeking emergency care, particularly elderly patients at risk for myocardial infarction or transient ischemic attacks, and extending hours of operation are recommended.

The article focuses on Great Britain's campaign to reduce mortality rates from heart attacks. It states that the use of sublingual nitrate sprays complicates self-diagnosis of heart attacks as the sprays relieve the pain from stable angina. It suggests that delaying a call leads to higher morbidity and mortality, but that being too cautious could overburden emergency medical services. The British Heart Foundation advises patients who know they have ischaemic heart disease that chest pain lasting over 15 minutes is likely a heart attack. This conflicts with a British Heart Foundation campaign suggesting members of the general public with potential "de novo" chest pain to call immediately. It mentions that campaigns have been unsuccessful in reducing mortality from acute coronary syndromes.

The article summarizes recommendations from Great Britain's National Institute for Health and Clinical Excellence (NICE) which were issued on effective secondary prevention in patients after myocardial infarction. A discussion of what the guidelines say about patient lifestyle, cardiac rehabilitation, and drug treatment in patients who have suffered myocardial infarctions, is presented. Arguments are presented which suggest that the effective implementation of the guidelines will depend on planning between specialists and general practitioners.

The article evaluates the coronary care unit (CCU) admission of elderly patients with acute myocardial infarction (AMI) in Great Britain. Data show that the oldest and more dependent patients without chest pain and those with longer time delays are usually denied admission to the CCU. However, this paper concludes that AMI in very old patients is associated with a very high mortality regardless of CCU admission.