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Objectives: To evaluate the impact the National Service Framework (NSF) far coronary heart disease has had on emergency treatment and outcomes in patients presenting with acute coronary syndromes. Design: Retrospective cohort study. Setting: Coronary care units of two district general hospitals. Results: Data from 3371 patients were recorded, 1993 patients in the 27 months before the introduction of the NSF and 1378 patients in the 24 months afterwards. After the introduction of the NSF in-hospital mortality was significantly reduced (95 patients (4.8%) v 43 (3.2%), p = 0.02). This was associated with a reduction in the development of Q wave myocardial infarction (40.6% v 33.3%, p < 0.0001) and in the incidence of left ventricular failure (15.9% v 12.3%, p = 0.003). The proportion of patients receiving thrombolysis increased (69.4% v 84.7%, p < 0.0001) with a decrease in the time taken to receive it (proportion thrombolysed within 20 minutes 12.1% v 26.6%, p < 0.0001 ). The prescription of 13 blockers (51.9% v 65.8%, p < 0.0001), angiotensin converting enzyme inhibitors (37% v 66.4%, p < 0.0001), and statins (55.2% v 72.7%, p < 0.0001) improved and the proportion of patients referred far invasive investigation increased (18.3% v 27.0%, p < 0.0001). Trend analysis showed that improvements in mortality and thrombolysis were directly associated with publication of the NSF, whereas the improvements seen in prescription of β blockers and statins were the continuation of pre-existing trends. Conclusions: In the two years that fallowed publication of the NSF the initial treatment and outcome of patients presenting with acute coronary syndromes improved. Some of the improvements can be attributed to the NSF but others are continuations of pre-existing trends. [ABSTRACT FROM AUTHOR]

The article presents a prospective study which investigates the relationship between subsequent fatal ischaemic heart disease (IHD) and psychological characteristics events. The study includes 1408 white men aged 40-64 years without a history of myocardial infarction to finish a Crown-Crisp experiential index form (CCEI). Results show that the associations were independent of social class, age, and known cardiovascular risk factors.

The trandolapril cardiac evaluation investigators reported a male to female ratio of sudden cardiac death in coronary disease of 1.4: 1. The low proportion of female subjects undergoing implantable cardioverter-defibrillator (ICD) implantation is well recognized and these data lead the authors to question whether there could be a sex bias in the referral or prescription of ICD in patients with coronary artery disease (CAD). The authors analysed the characteristics of 514 ICD implants performed between January 1990 and October 2002. Their study indicates that too few females with CAD are referred for an ICD.

The article focuses on a study related to myocardial hypertrophy in Friedreich's Ataxia (FA). FA is the commonest autosomal recessive spinocerebellar ataxia and is associated with cardiomyopathy, which may be hypertrophic or dilated. FA is caused by a triplet expansion in the FA gene. The consequent reduction in frataxin levels, which is a mitochondrial protein, is associated with mitochondrial iron overload, increased sensitivity to oxidative stress, and profound deficit of oxidative phosphorylation. Researchers previously showed that phosphocreatine/ATP in human heart measured by MR spectroscopy is reduced in FA patients irrespective of evidence of cardiomyopathy and increased towards normal by treatment with CoQ1 0 and vitamin E.