• R M Norris.
• Cardiac Department, Royal Sussex County Hospital, Brighton.
• BMJ. 1998 Apr 4; 316 (7137): 1065-70.

ObjectivesTo provide a contemporary account of the treatment and outcomes of acute coronary attacks in England and Wales and to identify strategies that might improve the outcome.DesignTwo year community and hospital based study in three British health districts.SettingHealth districts of Brighton (population 282,000), South Glamorgan (408,000), and York (264,000).Subjects3523 men and women under 75 years of age who died outside hospital from acute coronary causes, who were admitted to hospital with acute myocardial infarction, or who developed acute infarction or died unexpectedly from acute coronary causes while they were already in hospital.InterventionsAttempted resuscitation in people having a cardiac arrest outside hospital.Main Outcome MeasuresTotal case fatality, case fatality outside and inside hospital, and the effect of resuscitation on case fatality outside hospital.Results1589 patients died within 30 days of the acute event. Case fatality was 45% (95% confidence interval 43% to 47%), rising from 27% (160/595) (23% to 31%) at age < 55 years to 53% (1019/1916) (51% to 55%) at 65-74 years. Overall, 74% (1172/1589) (72% to 76%) of fatal events happened outside hospital, and there was a negative age gradient (P < 0.001) such that 91% (145/160) (87% to 95%) of fatalities occurred outside hospital at age < 55 compared with 70% (710/1019) (67% to 73%) at 65-74 years. Without successful resuscitation of 55 patients outside hospital, total case fatality at 30 days would have risen from 45% to 46.7%.ConclusionOpportunities for reducing fatality from acute coronary attacks lie mainly outside hospital. These results and others imply that survival from cardiac arrest outside hospital might be trebled by improved ambulance and patient response. Proper application of secondary preventive measures for patients with coronary disease could have an even larger impact.

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