Attaining The Health of the Nation targets for ischaemic heart disease: the contribution of a clinical outcome measure.

Abstract

Deaths occurring within 30 days of admission as a percentage of all admissions with acute myocardial infarction' was recently defined by the Scottish Office Clinical Resource and Audit Group as a clinical outcome measure for inclusion in service contracts between purchaser health authorities and provider NHS trusts. The aim of this study was to determine the extent to which improvements in the clinical outcome measure have already contributed and may continue to contribute to attaining the Health of the nation targets for ischaemic heart disease (IHD). Information was obtained from the computerized discharge summaries of patients treated in Tayside hospitals and the death registrations provided by the Registrar General for Scotland. In Tayside between 1980-1982 and 1990-1992, the number of death outside hospital from acute myocardial infarction (AMI) in the under-65s fell by 33 per cent, and the proportion of patients admitted as emergencies with AMI who died within 30 days fell by 40 per cent. The proportion of diagnosed heart attacks which proved fatal fell by a third over the period. As 75 per cent of deaths from IHD in the under-75s still take place before hospital admission, not more than 25 per cent of the overall fall in deaths from IHD can be accounted for by improvements in the clinical outcome measure. Most of the fall was apparently unrelated to immediate medical intervention after an attack, long-term nutritional and behavioural changes possibly having reduce the severity of diagnosed attacks. The Health of the nation targets cannot therefore be met by improvements in the clinical outcome measure alone.