Coronary heart disease (CHD) caused 115,000 deaths in England and Wales in 1999. CHD is becoming more prevalent as the population ages, resulting in greater need for revascularisation.

The overall secular trend of decline in mortality has not affected lower social classes to the same extent as higher social classes, resulting in greater disease burden and need among disadvantaged populations.

The National Service Framework (NSF) for CHD was introduced in 2000 with the aim of improving the quality of cardiovascular disease care and reducing inequity. This report provides a benchmark against which the impact of the NSF may be monitored.

There is good evidence that revascularisation procedures are effective in reducing mortality and morbidity, and in improving quality of life even in old age.

The Hospital Episodes Statistics database provides information on all inpatient and daycase admissions to hospitals in England from 1991 to 1999 (for financial years, i.e. to March 2000). There are approximately 97 million records in the database. These data have been used to examine trends in the use of revascularisation and to examine variation in use by gender, age, deprivation and geography.

There have been major increases in revascularisation rates nationally and in the South West region between 1991 and 1999. Rates in the South West started at a low base and have shown proportionately greater increases: rises of 146% (CABG) and 268% (PTCA) occurred between 1991 and 1999, compared with 66% and 205% for England.

Despite these encouraging trends, women and older people appear to receive less revascularisation than their level of need would indicate. An extra 540 CABG and 450 PTCA procedures in men and an additional 830 CABG and 2080 PTCA procedures in women would be required each year in the South West in order to achieve equitable treatment for older people up to the age of 80 years.

In men and women, revascularisation tends to be provided more to those in less deprived areas when account is taken of need, suggesting the 'inverse care law' is operating. An extra 1480 CABG and 1093 PTCA procedures a year in the South West would be needed in men and women respectively to remove deprivation inequity.

Revascularisation rates are generally lower in rural than urban areas, although this mirrors disease burden, suggesting no marked inequity by geography.

Relatively, rates of CABG are lowest in Dorset and highest for men in North and East Devon. Those districts containing regional revascularisation services (i.e. Avon and South & West Devon) have above average CABG rates, and in the case of Avon, lower PTCA rates. No consistent relationship with unstable angina rates, an indicator of need, is apparent.

Achieving equity of provision for men and women up to the age 80 years will require an increase in CABGs and PTCAs of about 50% and 140% respectively, which is relatively small compared with the increases achieved over the last decade.

Provision of cardiological and cardiovascular surgery services in the South West is low compared with the national averages for consultant staffing. Intensive care bed provision is also far lower than the national average but bed availability and theatre session provision are above the national average.