When the British Cardiac Society met in York in 1986, professor of economics Alan Williams addressed us on quality of life (QoL) measurements. He specifically dealt with their use to calculate the relative cost of gaining QALYs (quality adjusted life years) by interventions for angina.1 QALYs were to help health planners make more objective assessments of how our treatments performed in terms of value for money. Such analyses would enable us to make rational choices in deciding which treatment is the most cost effective for a given condition and, taken a step further, on which diseases and on which treatments money is best spent. By Williams’s calculations, the number of QALYs gained by interventions to relieve angina were modest, ranging from 0.5 for single vessel disease to 3.5 QALYs for a patient with left main stem stenosis with severe angina.1 It was evident that the scale he used was relatively insensitive to the effects of symptoms because a patient with a C rating for distress (scale A–D) and V for disability (scale I–VIII) still scored at 0.9 quality of life (scale 1–0).1

Perhaps it was unsurprising that the attitude of an audience of cardiologists, expanding their angioplasty practice, ranged from sceptical, through indignant, to down right hostile. Whether those involved in health policy will use QALYs in the allocation of resources remains an issue,2 but the concept of formal measurement of QoL has gained general acceptance. In 1992 theBMJ ran a series of articles on the subject.3-5 Inclusion of QoL measurement was to be the norm in therapeutic trials and in 1993 this journal published an editorial encouraging cardiologists to be more ready to understand and use them.6

In this month’s Heart we publish two prospective studies of five year follow up of …