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Best practice would cut coronary deaths by thousands

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Complying with best practice, as set out in the National Service Framework (NSF) for coronary heart disease (CHD) in England in 2000, will significantly reduce deaths after one year, say authors of a modelling study.

The impact would be greatest for patients with heart failure receiving drug treatment as per NSF recommendations—preventing 37 899 extra deaths one year after diagnosis compared with 1027 extra deaths in patients one year after acute myocardial infarction (MI). Adherence with lifestyle measures could prevent 7249 extra deaths in heart failure patients and 848 extra deaths in acute MI patients. Costs (at 2000 prices) for every death prevented are calculated at around £1500 for drug treatment and £1800 for lifestyle measures for heart failure compared with £6500 and £7900 for acute MI. The authors speculate that the drastic effect in heart failure deaths may reflect poor one year survival currently, which may itself suggest that current treatment may fall some way short of best practice.

The model used recently developed population impact measures—which quantify impact of public health recommendations—and published data from British sources, mostly, as available.

Many aspects of the measures underlying the data and the data themselves need to be improved, though, say the authors. Nevertheless, they maintain the method is sound and that with improved data we should be better able to translate the full potential of evidence based medicine into future planning of care for CHD at a population level.

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