An editorial in the British Medical Association journal Heart said that the only way to prevent these deaths would be to perform the operations as soon as the heart condition was diagnosed.

This is what happens in the private sector, it said, but NHS patients are often put on a waiting list because of other pressures to health service resources.

Only an "enormous injection" of cash could change the situation.

However, the British Heart Foundation (BHF) said it was inevitable that hospitals would have to prioritise treatments and prevention was just as important as surgery.

'Inevitable deaths'

Ben Bridgewater, a heart consultant at Wythenshawe Hospital in Manchester, wrote the article.

He was reviewing the findings of two studies - one from New Zealand and one from Holland - both of which indicated that it was inevitable that some patients would die while waiting for surgery.

This was even true in New Zealand, where a thorough system of clinical assessment is supposed to ensure the patients who need treatment most get it first.

Doctors in the UK have long called for such a system to be introduced in the NHS.

But, because any waiting at all seemed to result in some additional deaths, immediate surgery was the only way to cut mortality.

He said: "This currently happens in the UK in the private sector but will not happen in the NHS without an enormous injection of resources."

Conflicting demands

Systems that sought to prioritise patients also seemed destined to fail in the UK because of the conflicting demands placed on doctors.

"NHS surgeons usually manage their own waiting lists and in doing so they must balance a number of factors," he said.

"These roles are often conflicting and decision making can be difficult."

He suggested that around two per cent of heart patients die on a waiting list, but pointed out that three per cent died following the operation.

However, eliminating deaths among patients on waiting lists would have a significant impact on the overall number of deaths from heart conditions, he said.

Heart disease was about the only condition where intervention at the waiting list stage could affect the overall death rate, he said.

Prioritisation

A spokesman for the BHF said: "Most hospitals are going to have some form of prioritising to decide which patients are in most urgent need.

"The fact of life is that within the NHS as a whole there's probably not enough money to go round."

He said that prevention - whether before a first heart attack or preventing a second - was essential, and surgery was not necessarily the only tool in maintaining a healthy heart.

And the National Service Framework - which will set out national standards of care - should help to iron out any regional inequalities in access to care when it is published, he said.