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Focuses on the assessment of the value of sending a mobile coronary care unit (MCCU) to all emergency calls in Great Britain. Statistics on prehospital mortality among patients with heart attacks aboard MCCU; Information on the survival rates of patients sent to hospitals on routine ambulances; Details on the equipment on emergency ambulances.

Assesses the attitude of general practitioners to management of patients with heart attack. Number of doctors prepared for an unqualified choice of home or hospital treatment for a middle-aged man with uncomplicated attack; Effect of the date of the practitioner's qualification in advising bed rest; Role of location of practice on physician's attitude.

Evaluates the relative importance of medical examinations in the diagnosis and management of medical outpatients in Great Britain. Factors in determining the diagnosis of a patient; Identification of the different stages in making a diagnosis; Implications of a medical history-based diagnosis.

Focuses on the trial of early nifedipine in acute myocardial infarction. Description of nifedipine; Occurrence of deaths in patients with myocardial infarction; Administration of nifedipine treatment in patients.

Examines the efficacy of coronary artery bypass graft in Europe. Benefits from a bypass; Conduction of a randomized trial in patients with angina pectoris; Effectiveness of bypass surgery in treating patients with the disease.

Investigates home care management for patients with suspected myocardial infarction in Nottingham, England. Comparison between home care and hospital admission; Implication of identical service of physicians for patient management; Influence of hospital facilities on patient care.

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.

Presents a comparative study of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. Treatment of stable angina; Similarity of procedures in terms of symptoms and survival; Cost considerations.

Examines the impact of clinical trials on the treatment of high blood pressure in Europe. Association between high blood pressure and cardiovascular disease; Guidelines for clinical practice; Effect of treatment on the survival and cardiovascular events.

Aims A large number of drugs are currently used for the treatment of chronic heart failure. Treatment for other cardiovascular disorders has been shown to differ between countries. In this study we examined whether this would also be true in heart failure. Methods and Results We studied patients with moderate to severe heart failure, who were enrolled in an international survival study, and compared patterns of drug use between the nine countries that each included >50 patients in the study. The results were analysed to determine whether observed differences between countries could be explained by differences in the patients recruited. 1825 patients were studied (range 81–427 per country). By trial protocol, most patients were treated with angiotensin converting enzyme (ACE) inhibitors (92%) and all with diuretics, but the proportion of patients taking high doses of these drugs was markedly different between countries. Large differences were also observed in the use of digoxin (overall 64%, 39% in the U.K. to 87% in Germany) and antiarrhythmics (overall 25%, with the highest use 44% in France). The use of beta-blockers and calcium antagonists was low (overall 6% and 8%, respectively), but also different between countries. Anticoagulants (overall 43%) were used in many patients in the Netherlands and Switzerland (around 70%), while antiplatelets (overall use 30%) were most often prescribed in Denmark (51%). Conclusions Large differences in drug use and dosing for patients with advanced heart failure are observed between (European) countries. None of these differences could be explained by differences in patient characteristics, and whether they are related to factors such as tradition, economic circumstances and national guidelines, etc. is unknown. [ABSTRACT FROM PUBLISHER]

Aims To investigate whether an ambulance crew’s length of experience affected the outcome of out-of-hospital cardiac arrest.Methods and Results This was a population-based, retrospective observational study of attempted resuscitations in 1547 consecutive arrests of cardiac aetiology by Nottinghamshire Emergency Ambulance Service crew. One thousand and seventy-one patients were managed by either a paramedic or a technician crew, without assistance from other trained individuals at the scene of arrest. Overall, the chances of a patient surviving to be discharged from hospital alive did not appear to be affected by the paramedic’s length of experience (among survivors, 18 months experience vs non-survivors 16 months experience, P=0·347) but there appears to be a trend in the effect of a technician’s length of experience on survival (among survivors, 60 months experience vs non-survivors 28 months experience, P=0·075). However, when a technician had 4 years of experience or more and a paramedic 1 year’s experience, survival rates did improve. Logistic regression analysis, adjusted for factors known to influence outcome, revealed that chances of survival increased once technicians had over 4 years of experience after qualification (odds ratio 2·71, 95% CI 1·17 to 6·32, P=0·02) and paramedics after just 1 year of experience (odds ratio 2·68, 95% CI 1·05 to 6·82, P=0·04).Conclusions Survival from out-of-hospital cardiac arrest varies with the type of ambulance crew and length of experience after qualification. Experience in the field seems important as paramedics achieve better survival rates after just 1 year’s experience, while technicians need to have more than 4 years’ experience to improve survival. [ABSTRACT FROM PUBLISHER]

BackgroundThere has been conflicting evidence of the effect of angiotensin-converting enzyme (ACE) inhibitors on exercise tolerance. Meta-analysis of published results has suggested that a beneficial effect of ACE inhibitors is demonstrated if a trial design is adequate.SettingMulticentre International Trial.MethodsIn a double-blind, randomized, multicentre trial, 292 patients with moderate (New York Heart Association Grades II and III) heart failure were treated with trandolapril or placebo in addition to diuretics, and followed for 16 weeks. Exercise tolerance on a treadmill was assessed at baseline and after 4, 8, 12 and 16 weeks of treatment. Both a modified Bruce and a modified Naughton protocol were used.ResultsExercise tolerance improved in both treatment groups, with no significant benefit from trandolapril treatment.ConclusionTrandolapril does not improve exercise tolerance as measured by treadmill testing. [ABSTRACT FROM PUBLISHER]

AimsHeart failure is a major medical problem in the elderly. Neurohormonal activation plays a role in the pathophysiology of heart failure, but is also affected by ageing. The present study was carried out to examine the influence of age on neurohormonal activation and prognosis in patients with chronic heart failure.Methods and ResultsWe studied 372 patients with moderate to severe chronic heart failure (New York Heart Association [NYHA] functional class III–IV), who were treated with angiotensin converting enzyme (ACE) inhibitors (95%), diuretics (99%), and digoxin (59%). Their mean age was 68±8 years (range 38–80), left ventricular ejection fraction 0·23±0·08, and 77% were males. The relationship between age and plasma neurohormones (norepineprine, epinephrine, dopamine, renin, aldosterone, atrial natriuretic peptide, N-terminal atrial natriuretic peptide, and endothelin), and age and prognosis was examined. Only atrial natriuretic peptide and N-terminal atrial natriuretic peptide showed an independent, positive correlation with age (P<0·0001). On univariate analysis, norepinephrine also increased, while renin and aldosterone decreased (allP<0·05). As regards mortality (25%), there was no linear increase with ageing for the group as a whole during follow-up, but patients in the highest age quartile (>74 years) had a significantly higher mortality (risk ratio 1·9) than younger patients (P<0·05).ConclusionsAlthough several plasma neurohormones are affected by ageing on univariate analysis, only atrial natriuretic peptide and N-terminal atrial natriuretic peptide show a highly significant increase with ageing on multi-variate analysis. There is no linear increase in mortality with ageing, but in the truly elderly heart failure patients (>74 years), age alone was an independent predictor for mortality. [ABSTRACT FROM PUBLISHER]