title: Impact of the National Service Framework for coronary heart disease on treatment and outcome of patients with acute coronary syndromes.
abstract: OBJECTIVE
  To evaluate the impact the National Service Framework (NSF) for coronary heart disease has had on emergency treatment and outcomes in patients presenting with acute coronary syndromes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  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 beta 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 for 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 beta blockers and statins were the continuation of pre-existing trends.
  
  
  CONCLUSIONS
  In the two years that followed 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.
authors.affiliation: Department of Cardiology, Barts and the London NHS Trust, London Chest Hospital, London, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Graham
authors.forename: A
authors.initials: A
authors.lastname: Timmis
authors.forename: J
authors.initials: J
authors.lastname: Cooper
authors.forename: S
authors.initials: S
authors.lastname: Ramdany
authors.forename: A
authors.initials: A
authors.lastname: Deaner
authors.forename: K
authors.initials: K
authors.lastname: Ranjadayalan
authors.forename: C
authors.initials: C
authors.lastname: Knight
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D003325:Coronary Care Units; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D004638:Emergency Treatment / Q000379:methods / Q000639:trends*; D005260:Female; D017052:Hospital Mortality; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008131:London / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D013577:Syndrome; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000517:prevention & control
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin