Medical management and the decline in mortality from coronary heart disease.

The contribution of resuscitation before admission to hospital, coronary care units, treatment with beta blockers after myocardial infarction, coronary artery bypass surgery, and the treatment of hypertension to the decline in mortality from coronary heart disease in Auckland between 1974 and 1981 was assessed by using data from several population based studies. There were 126 fewer deaths from coronary heart disease in Auckland in 1981 than expected from the 1974 rates among people less than 70 years. The specific medical interventions probably accounted for about 51 (40%) of the 126 fewer deaths. Local data indicate that resuscitation before admission to hospital was responsible for 20 (16%) of the 126 fewer deaths. Projections based on local data and trials carried out overseas suggest that up to 15 (12%) of the 126 fewer deaths were due to the treatment of hypertension. Coronary care units and the use of beta blockers after myocardial infarction were estimated to be responsible for six (5%) and three (2%) of the 126 fewer deaths, respectively. The impact of coronary surgery was especially difficult to determine in the absence of appropriate randomised controlled trial data. Estimates of its contribution ranged from seven to 23 (5% to 18%) of the 126 fewer deaths.