Some aspects of management and outcome of acute coronary heart disease in Oxford region.

(1) Over 15 months, 532 consecutive admissions to the CCU at the Radcliffe Oxford were studied; of these 333 were cases of myocardial infarction, and 319 were first admissions for this condition. Information about survival and return to work was collected for 300. A further 30 had artificial pacemakers inserted; there were 141 (26%) of the 532 cases which did not require the special care offered by the CCU. (2) Of 300 patients for whom data were available, 27 were recorded as having received DC shock. In hospital, case fatality was significantly higher among those requiring DC shock than among the remainder. Overall the 3-year survival rates were 47 per cent among those receiving shock, and 62 per cent among the remainder, compared with an expected 91 per cent for a population of the same age and sex. (3) Among men aged under 65 years, 6 of 11 who received shock, compared with 117 (77%) who did not receive shock, returned to work after leaving hospital. (4) Rates of admission to the CCU of cases of myocardial infarction per 1000 standardised population among people living in the areas around Oxford City were estimated as being 58 per cent of admission rates of cases among residents of the city. (5) The case incidence of ventricular fibrillation and the case fatality rate were both higher among those living in the environs than among those living in the city, but these differences were not statistically significant. (6) It is also concluded that insufficient is known about the factors underlying the general practitioner's decision to commit a case of myocardial infarction to other than short ambulance journeys or about the effects of such journeys on prognosis.