By studying all coronary heart attacks presenting within defined communities it should be possible to avoid the distortions and omissions inherent in hospital-based case series. In practice the technique presents several problems. Measures of frequency and outcome are very sensitive to the diagnostic criteria used. Data of varying quality are mixed and specific attack rates can be calculated only for items for which the census provides a denominator. Patients presenting to different medical services have different outcomes, but probably less because of treatment than because the severity of the attack affects behaviour in it. Despite these problems, some such intelligence system is of value in any comprehensive strategy for coronary heart disease.
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