Definitive proof of the potential value of medication is obtained from randomized controlled trials, but population studies are needed to demonstrate their usage and population impact. Data on acute coronary events in men and women aged 25-64 have been collected from North Glasgow during a decade (1985-94) of rapid change in medication. Registration of events which satisfied World Health Organization criteria for definite myocardial infarction or for coronary death yielded 5,472 events in men and 2,139 in women. Among the items recorded were previous medical history, medication prescribed before the onset of the attack, medication after the onset, place of care, place of death and survival up to 28 days from the onset. During the first seven years of registration (1985-91) there was a revolution in medication given after the onset of the attack, with major increases in usage of thrombolytic drugs, aspirin and beta-blockers, but there was little attendant change in population or hospital case fatality. In 1992-94 case fatality fell but most of the decline was in sudden death outside hospital, the remainder occurring in patients reaching coronary care. Cross-sectional analyses show that long-term medication for previous coronary heart disease substantially reduced the risk of out of hospital death in recurrent events. For various reasons the data have to be interpreted with care, but they suggest that secondary prevention may be of greater potential impact on population case fatality, and therefore on coronary deaths, than is emergency care after the onset of the attack.
|Published - May 1 1997
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine