Provision of care for heart patients in the UK is inadequate, even though rates of the disease are among the highest in the world, say doctors.

Heart disease is the number one killer in Britain, claiming the lives of one in four men and one in six women.

People with significant heart disease should be entitled to see a specialist in cardiac medicine at some time during the course of their problems

Professor John Camm

Among developed countries, only Ireland and Finland have a worse record.

The British Cardiac Society and the Royal College of Physicians have joined forces to examine the state of coronary heart disease care nine years on from a similar exercise.

The report recognises important advances have been made in the organisation and funding of cardiovascular care.

It says there have been major improvements in a number of clinical areas, such as restabilising the blood flow to the heart and dissolving blood clots.

UK heart operations (year to March 2000)

Bypass surgery 24,728 (2.2% death rate) Valve surgery 5,394 (5.5%) Bypass and valve surgery 2,641 (7.8%) Operations for ischaemic heart disease 462 (17.1%)

And health professionals involved in the care of heart patients - including GPs - have begun to work together more closely to provide more integrated care.

However, the report says there are still major concerns, and makes a number of recommendations aimed at improving the situation.

It says that the government's National Service Framework for Coronary Heart Disease needs to be implemented more consistently throughout the UK to put an end to big regional variations in the quality of care.

Other conditions

It warns that the framework has led to an over-emphasis on coronary heart disease at the expense of other heart problems.

And it says a greater focus is needed on conditions such as complex heart rhythm problems, heart muscle and valve disease, and congenital disease in both children and adults.

The report also recommends:

• Patients are given a greater say in planning of services
• An increase in specialist staff to maximise the number of patients who are seen by people with expertise in the field
• An extra 1,500 consultant cardiologists by 2010
• An upgrade of IT
• A major reorganisation of working practices to include assessment of the feasibility of using ancillary staff such as surgeon and physician assistants

Professor John Camm, president of the British Cardiac Society, told BBC News Online: "There has been a good deal of improvement since the National Service Framework, but we are still currently behind most of the other developed countries in Europe, and far behind the US."

Professor Camm said that the US, which has a population roughly four times that of the UK, has 24,000 cardiologists. In the UK the figure is 630.

"Without basic manpower the service simply cannot be provided to the level that it ought.

"People with significant heart disease should be entitled to see a specialist in cardiac medicine at some time during the course of their problems. At present, only about a third do.

"An expert in general medicine will provide the best care that he or she can, and the patient may be unaware of the difference.

"But cardiologists tend to be much more knowledgeable about the field, and to be more aggressive in their treatment strategies."