Attitudes of general practitioners towards their vaccination against hepatitis B.

effective and lifesaving treatment. Differences in the incidence of acute myocardial infarction across the country cannot explain the variation in clinical practice observed, and any error due to the use of thrombolytic agents for other conditions was probably small. The median treatment rate of five patients per 100 000 each month suggests that 30 000 patients are treated annually in England. If the highest rates that we found were achieved nation wide a further 60000 patients would be treated. Is this a realistic estimate of the shortfall? The rate of infarction is not known accurately. The British Heart Foundation quotes 240 000 each year in Great Britain based on pooled data (estimates range from 146 000 to 362 000). This is equivalent to 205 000 infarcts in England. Almost half are immediately fatal, which corresponds with the crude death rate from myocardial infarction in England (nearly 90000 deaths in 1988).' Most survivors attend hospital, and at least half are eligible for thrombolysis.4 From these estimates and our data we calculate that each year about 20000 (possibly as many as 60000) eligible patients do not receive thrombolysis in England. Such undertreatment may have medicolegal implications.5