Heart-attack survivors across the country are dying needlessly because they are not receiving recommended after-care, a new study suggests.
Thousands of patients have died because of widespread suboptimal use of recommended treatments for the most common type of heart attack - a non-ST elevation myocardial infarction (NSTEMI), the research suggests.
Across England just 13.5% of people received optimal care, according to the study published in the journal BMJ Open.
As a result, there was a median of 39 excess deaths across England's 232 hospitals between 2003 and 2013 - with 15 additional deaths recorded at the best-performing hospitals and 62 needless deaths at the worst.
Researchers examined more than 350,000 NSTEMI patients treated across the country to see whether they were given recommended care including: being prescribed statins, aspirin or anti-clotting drugs, receiving an ecocardiogram or being given advice on diet or stopping smoking.
The most frequently missed guideline interventions were advice on diet and smoking cessation, according to the study, which was funded by the British Heart Foundation (BHF) and the National Institute for Health Research.
Many were not prescribed recommended anti-clotting drugs when leaving hospital and over half of the patients (58.1%) were not under the care of a cardiologist.
The authors, from the University of Leeds and University College London, concluded: "Over a 10-year study period, we found evidence for widespread suboptimal use of guideline-indicated treatments for the management of NSTEMI."
Earlier this year, a separate study found that around 33,000 deaths could have been avoided over a 10-year period if heart attack after-care guidelines were followed at hospitals across England and Wales.
The BHF said that the care received by patients across the country "varies widely" across the country.
In the North East and Cumbria, 20% of patients received all appropriate treatments but in the East Midlands just 10% received the optimal level of care, BHF said.
Professor Peter Weissberg, medical director at the BHF, said: "This study shows that many people in the UK are not receiving optimal care after a heart attack.
"The study shows there is much room for improvement. All hospitals should review their guidelines and ensure that they are appropriately applied to all patients.
"Applying clinical guidelines in heart disease costs little and in the long term saves money and, most importantly, saves lives."