Cardiology in a district hospital.

During 1975-81 a non-invasive cardiac unit was established at St Peter's Hospital, Chertsey, a district hospital serving a population of 202 000. There was a progressive increase in outpatient referrals in cardiology, and in 1981 non-invasive investigations included 424 echocardiograms, 305 exercise electrocardiograms, 275 ambulatory electrocardiograms, and 147 thallium-201 studies. Between 1979 and 1981, 151 patients were admitted directly to major centres for further investigation; 74% of those with ischaemic heart disease and 68% of those with valvular heart disease subsequently underwent surgery, a ratio of investigation to surgery that is half the norm for the four metropolitan regions. Based on the 1981 figures, which were substantially above those for 1980, there is a need for a minimum of 270 open heart operations per million of the population including 180 vein bypass operations. This figure for bypass grafting is 230% higher than in the United Kingdom as a whole in 1978 and has substantial implications.