The performance of the St Mary's Hospital London W2 coronary care unit was studied in each of 2 years, 1969 and 1975, results of which could be compared with each other and with national figures from the annual reports of the Hospital In-patient Enquiry. In 1975 the admissions were 42% more than in 1969; the increase was confined to mild cases over 45 years of age, and was out of proportion to national trends. The hospital fatality rate was unchanged and when age-standardized was 69% and 78% of contemporaneous national rates. In both years, 50% of the patients admitted came from outside the health district and 10% of local admissions were visitors from abroad. In 1975 there was an increased proportion of ex-smokers among the patients and more gave a history of previous myocardial infarction. The value and limitations of this kind of surveillance of a clinical unit are argued.
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