Over a one-year period, i858 episodes of suspected acute heart attack occurring in the Edinburgh population under the age of 70 were documentedfrom a notification survey conducted by a special team in liaison with general practitioners, hospitals, and police surgeons.The overall annual incidence of episodes of acute heart attack in the population aged 40 While epidemiological studies have made a major contribution to knowledge about some of the causes of coronary heart disease, the natural history of acute heart attacks is still obscure. Though it is now known that efficient intensive care can prevent some early deaths in those surviving long enough to reach hospital (Lawrie et al., i967), further advances must depend upon a better understanding of this natural history. In order to obtain information about the sequence of events immediately after such attacks, an attempt was made to record data about every acute coronary heart attack in the city of Edinburgh over a period of one year. The preliminary findings have already been reported (Fulton, Julian, and Oliver, I969) and this definitive report sets out 'to complete the clinical picture' (Morris, i964) of acute heart attacks and thus to provide a factual basis for

SummaryThe natural history of new and worsening angina pectoris was studied in 251 men aged under 70 years. Most were ambulant and all were referred by selected general practitioners to a special hospital clinic over two and a half years. Heart attacks developed in 39 patients, nine of whom died. Seventy-two per cent of the attacks occurred within six weeks of the onset or worsening of angina. Of the 212 patients who did not suffer myocardial infarction and who were clinically reviewed six months after their first attendance 66 had been pain free for the previous three months and 14 had experienced only infrequent attacks of angina. Of the 128 men aged under 65 years who were previously in employment 810 had returned to fulltime work six months after their first attendance.A discriminant function analysis using many variables was made to develop a predictive index that would allow patients with new or worsening angina who were likely to develop serious cardiac complications to be identified.

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Background and aims Novel psychoactive substances are compounds intended to mimic the effects of illicit drugs. They provide a unique challenge to healthcare, as complications of their use and their impact on services are relatively unknown. This study aims to determine nature of presentations, patient demographics and impact on healthcare. Methods Novel psychoactive substances users who presented to a large urban emergency department over 4 weeks were prospectively identified and followed for 1 year. Patients over 13 years old were eligible for inclusion. Information regarding patient demographics and presentations was collected. Results During the study period, 53 patients (39 male), mean age 32.6 ± 8.9 (±standard deviation), presented 148 times with complaints relating to novel psychoactive substances use. Study population characteristics included history of illicit drug use (83.0%), intravenous drug use (64.2%), psychiatric diagnosis or symptoms (56.6%), methadone prescription (52.8%) and having no fixed abode (37.7%). Injection was the most common method of use (72.3%), Burst the most commonly named agent (19.6%) and behavioural change the most common presenting complaint (31.1%). Patients collectively spent 10,620 h in hospital over 1 year. Conclusion This study highlights differences between the young population targeted by government campaigns regarding novel psychoactive substances use and the presenting population to hospital, and the associated burden on the National Health Service.