Progress Against Heart DiseaseBMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7492.677 (Published 17 March 2005) Cite this as: BMJ 2005;330:677
- Harry Hemingway, reader in clinical epidemiology ([email protected])
- University College London
Angina Pectoris, a film written and directed by J E F Riseman, won no Oscars, had no famous stars, and failed to secure even the most limited distribution deal. For those who have not seen the film, its actors are anonymous medical men demonstrating state of the art diagnostic assessment of patients with angina. A careful history of the characteristics of the pain and standardised investigation with resting and exercise electrocardiography are recommended. That all sounds familiar? Of course it does—not only professional bodies but even governments now issue guidance on such diagnostic assessments. The film was made in 1943.
Pampel and Pauley's book was published in 2004. In what sense have we made progress? Consider diagnosis. Clearly, many new diagnostic tests have been introduced in the six decades since Riseman's film. However, the proportion of patients undergoing coronary angiography in whom no narrowed arteries are detected—20% to 30%—has changed little in the past three decades. This raises the question …
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