Fatality Outside Hospital From Acute Coronary Events In Three British Health Districts 1994-5

April 03, 1998

(Fatality outside hospital from acute coronary events in three British health districts 1994-5)

In a study of patients who had heart attacks in the health districts of Brighton, South Glamorgan and York over a two year period, Norris, on behalf of the UK heart attack study investigators found that nearly three quarters (74 per cent) of all fatal cases happened before it was possible to transfer patients to hospital. Norris notes that hospital treatment for coronary conditions has improved greatly over the past 20 years but fatality rates outside hospital remain very high. The total case fatality for people under 55 years of age was 27 per cent, but once patients reached hospital it fell to three per cent.

With these statistics in mind Norris and colleagues say that opportunities for reducing fatality from acute coronary attacks lie mainly outside hospitals and in the wider community and they make four recommendations. Firstly, the authors believe that the survival rate from cardiac arrests occurring whilst at home or work, for example, might be trebled by an improved ambulance response. Secondly, they recognise that in 60 per cent of cases, cardiac arrests are witnessed by by-standers, of whom less than one third attempt resuscitation procedures. Therefore, citizen training in cardiopulmonary resuscitation could be crucial.

Thirdly, as many more heart attack victims survive if they arrest in the presence of a paramedic then the public should be educated to call the emergency services if they or a relative are with someone who has experienced chest pain lasting for more than 15 minutes. Finally, Norris advocates the benefits of secondary prevention of coronary attack in the form of medication which lowers cholesterol concentrations, antiplatelet drugs and beta blockers, not to mention strenuous advice to stop smoking.


R Norris, Honorary Consultant Cardiologist, Cardiac Department, Royal Sussex County Hospital, Brighton


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