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Over 20 000 avoidable coronary deaths in England and Wales in 2000: the failure to give effective treatments to many eligible patients
  1. S Capewell1,
  2. B Unal1,*,
  3. J A Critchley1,
  4. J J V McMurray2
  1. 1Department of Public Health, University of Liverpool, Liverpool, UK
  2. 2CRI Heart Failure, University of Glasgow, Glasgow, UK
  1. Correspondence to:
    Professor Simon Capewell
    Department of Public Health, Whelan Building, The Quadrangle, The University of Liverpool, Liverpool L69 3GB, UK; capewell{at}

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Many evidence based cardiological treatments reduce coronary heart disease (CHD) deaths. These treatments together explained over 40% of the substantial fall in CHD deaths between 1981 and 2000.1 However, the CHD National Service Framework (NSF) recognised in 1999 that barely half of all eligible patients actually received effective treatments for myocardial infarction (MI), angina, or heart failure. Uptake rates were consistently worse among women, the elderly, and the deprived.2,3 This study therefore examined the reduction in CHD deaths potentially achievable through increasing treatment levels in England and Wales.


The previously validated cell based IMPACT model was used to combine data on (1) numbers of patients in specific CHD groups; (2) the prescription rates for all standard CHD treatments in 2000; and (3) the effectiveness of these treatments, defined as survival benefit over a minimum of one year, from the largest and most recent meta-analyses or randomised controlled trials.1 Cumulative benefit from polypharmacy in individual patients was estimated by the Mant and Hicks formula, where relative benefit  =  1 − (1 − treatment A) × (1 − treatment B) × (1 − treatment C), etc. Compliance (concordance) for medical treatment was assumed to be 100% while patients were in hospital, 70% among symptomatic patients with angina or heart failure, and 50% among patients with hypertension or increased cholesterol. Uptake level was defined as prescription rate times adherence.1

Having estimated the actual reduction in CHD deaths in 2000, we then …

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  • * Also the Department of Public Health, Dokuz Eylul University School of Medicine, Izmir, Turkey

  • Source of support: Belgin Unal was funded by an NHS North West Regional Research and Development Training Fellowship.