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The authors’ reply:
  1. M R Cowie1,
  2. E D Nicol2,
  3. B Fittall2,
  4. M Roughton3,
  5. J G F Cleland4,
  6. H Dargie5
  1. 1
    British Society for Heart Failure, and Imperial College London, London, UK
  2. 2
    Healthcare Commission, London, UK
  3. 3
    Royal Brompton Hospital, London, UK
  4. 4
    University of Hull, Kingston-upon-Hull, UK
  5. 5
    Cardiac Department, Western Infirmary, Glasgow, UK
  1. Professor M R Cowie, Imperial College London, Dovehouse Street, London SW3 6LY, UK; m.cowie{at}

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The letter by Dr McMurray and colleagues raises several very important points.

Despite similar population demographics in Scotland and England,1 the average age of patients hospitalised for heart failure in Scotland is lower by about 3 years. This may be partly related to the greater burden of ischaemic heart disease, the main underlying cause of heart failure, in Scotland.2 Despite this increased burden, the length of stay and in-hospital mortality for heart failure is significantly lower in Scotland, and is much closer to that reported from continental Europe and North America.3 It would be interesting to compare quality measures between Scotland and …

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  • Competing interests: None declared.

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