Table 1 Coronary heart disease mortality reduction in England and Wales in 2000: effect of increasing treatment levels to reach 80% of eligible patients.
| Treatment | Eligible patients | Treatment | Deaths prevented or postponed* | |||||
|---|---|---|---|---|---|---|---|---|
| Level in 2000 | Efficacy (RRR) | In 2000 | Gain if 80% treatment level | Total gain | Minimum estimate | Maximum estimate | ||
| Acute myocardial infarction | 66195 | 5755 | 2370 | 11% | 1329 | 3414 | ||
| Community resuscitation | 3045 | 0.046 | 0.11 | 799 | 381 | |||
| Hospital resuscitation | 7280 | 0.99 | 0.21 | 1453 | 0 | |||
| Thrombolysis† | 0.47 | 0.21 | 1321 | 50 | ||||
| Aspirin | 0.94 | 0.15 | 1949 | 0 | ||||
| Primary angioplasty‡ | 0.01 | 0.28 | 38 | 1331 | ||||
| β Blockers | 0.04 | 0.04 | 21 | 197 | ||||
| ACE inhibitors | 0.19 | 0.07 | 172 | 409 | ||||
| 2° prevention after infarction | 313380 | 3845 | 3695 | 18% | 2741 | 4865 | ||
| Aspirin | 0.56 | 0.15 | 1242 | 67 | ||||
| β Blockers | 0.34 | 0.23 | 969 | 721 | ||||
| ACE inhibitors | 0.19 | 0.23 | 442 | 916 | ||||
| Statins | 0.25 | 0.29 | 459 | 644 | ||||
| Warfarin§ | 0.04 | 0.15 | 100 | 250 | ||||
| Rehabilitation | 0.23 | 0.27 | 673 | 1057 | ||||
| 2° prevention after revascularisation | 157840 | 3055 | 985 | 5% | 561 | 1638 | ||
| Aspirin | 0.56 | 0.15 | 821 | 99 | ||||
| β Blockers | 0.35 | 0.23 | 568 | 148 | ||||
| ACE inhibitors | 0.22 | 0.23 | 349 | 268 | ||||
| Statins | 0.34 | 0.29 | 677 | 203 | ||||
| Warfarin§ | 0.04 | 0.15 | 54 | 117 | ||||
| Rehabilitation | 0.35 | 0.27 | 586 | 152 | ||||
| Angina revascularisation | 2495 | 400 | 2% | 270 | 560 | |||
| CABG surgery | 187415 | 1.00 | 0.31 | 1935 | 276 | 233 | 381 | |
| Angioplasty¶ | 112405 | 1.00 | 0.08 | 559 | 124 | 36 | 181 | |
| Unstable angina | 67375 | 915 | 305 | 1% | 224 | 419 | ||
| Aspirin and heparin | 0.59 | 0.27 | 467 | 165 | ||||
| Aspirin alone | 0.30 | 0.15 | 234 | 0 | ||||
| Gp IIB/IIIA inhibitors and clopidogrel | 0.48 | 0.09 | 211 | 141 | ||||
| Chronic stable angina | 2114670 | 1100 | 1475 | |||||
| Aspirin | 0.58 | 0.15 | 995 | 370 | 2% | 234 | 790 | |
| Statins | 0.07 | 0.29 | 105 | 1105 | 5% | 958 | 1471 | |
| Heart failure in hospital | 34690 | 4755 | 3350 | 16% | 2178 | 6206 | ||
| ACE inhibitors | 0.62 | 0.26 | 1848 | 595 | ||||
| β Blockers | 0.31 | 0.37 | 1278 | 1044 | ||||
| Spironolactone | 0.10 | 0.30 | 348 | 990 | ||||
| Aspirin | 0.50 | 0.15 | 870 | 119 | ||||
| Statins | 0.21 | 0.29 | 412 | 700 | ||||
| Community heart failure | 242090 | 3210 | 3935 | 19% | 1020 | 3048 | ||
| ACE inhibitors | 0.56 | 0.26 | 1536 | 34 | ||||
| β Blockers | 0.15 | 0.37 | 550 | 1595 | ||||
| Spironolactone | 0.10 | 0.30 | 206 | 965 | ||||
| Aspirin | 0.29 | 0.15 | 585 | 579 | ||||
| Statins | 0.17 | 0.36 | 333 | 763 | ||||
| Hypertension treatments | 13352870 | 0.53 | 0.11 | 1885 | 945 | 4% | 438 | 1586 |
| Statins for 1° prevention | 7630760 | 0.03 | 0.29 | 145 | 3295 | 16% | 1078 | 5493 |
| Total | 25805 | 20910 | 100% | 11030 | 33495 | |||
*Deaths prevented were calculated by multiplying the age specific case fatality rate by the estimated relative risk reduction; †60% maximum uptake assumed; ‡40% maximum uptake assumed; §20% maximum uptake assumed for warfarin if 80% of patients were taking aspirin; ¶Assuming relative risk reduction (RRR) of 8%, equivalent to coronary artery bypass graft (CABG) surgery for two vessel disease.
ACE, angiotensin converting enzyme; Gp, glycoprotein.