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Two years on, the National Service Framework (NSF) for coronary heart disease (CHD) in the UK has improved health outcomes, with lower mortality and more uniform and timely treatment, a retrospective before and after review in two London hospitals has shown. Setting clear, unambiguous targets within regularly audited guidelines can benefit care, say the study’s authors.
Significant improvements directly related to the intervention in patients with acute coronary syndromes or myocardial infarction were lower mortality—falling by a third after the NSF was implemented in April 2000—and fewer patients with Q wave myocardial infarction and left ventricular failure; also more eligible patients received thrombolysis and sooner. However, increased use of ACE inhibitors and more referrals for revascularisation might be attributable to other guidelines, and use of β blockers and statins increased in line with existing trends. The two patient groups were similar demographically, and the NSF was the only variable to account for the findings.
The review compared patients in the coronary care units of the east end London hospitals which serve 700 000 people and where a database, set up in 1998, charts treatment and outcomes of all admissions with acute coronary diagnoses. During 1998–2002, 1993 patients in the 27 months before the NSF was implemented were compared with 1378 patients 21 months after.
The NSF was introduced by the government in March 2000 to curb deaths from CHD by 40% over 10 years and to end regional variation in treatment—or “postcode prescribing.”
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