1. Management and outcomes of patients with acute coronary syndromes in Australia and New Zealand, 2000-2007.
- Author
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Aliprandi-Costa B, Ranasinghe I, Chow V, Kapila S, Juergens C, Devlin G, Elliott J, Lefkowitz J, and Brieger DB
- Subjects
- Angioplasty, Balloon, Coronary statistics & numerical data, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Anticoagulants therapeutic use, Australia epidemiology, Coronary Angiography, Coronary Artery Bypass statistics & numerical data, Drug Utilization statistics & numerical data, Drug Utilization trends, Heart Failure epidemiology, Heparin therapeutic use, Hospital Mortality trends, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, New Zealand epidemiology, Patient Readmission statistics & numerical data, Patient Readmission trends, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Practice Guidelines as Topic, Quality of Health Care, Registries, Stroke epidemiology, Acute Coronary Syndrome mortality, Acute Coronary Syndrome therapy, Outcome Assessment, Health Care
- Abstract
Objectives: To describe temporal trends in the use of evidence-based medical therapies and management of patients with acute coronary syndromes (ACS) in Australia and New Zealand., Design, Setting and Participants: Our analysis of the Australian and New Zealand cohort of the Global Registry of Acute Coronary Events (GRACE) included patients with ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation ACS (NSTEACS) enrolled continuously between January 2000 and December 2007 from 11 metropolitan and rural centres in Australia and New Zealand., Results: 5615 patients were included in this analysis (1723 with STEMI; 3892 with NSTEACS). During 2000-2007 there was an increase in the use of statin therapy, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and thienopyridines (P < 0.0001 for each). Among patients with STEMI, there was an increase in emergency revascularisation with PCI (from 11% to 27% [P < 0.0001]), and inhospital coronary angiography (from 61% to 76% [P < 0.0001]). Among patients with NSTEACS, there was an increase in revascularisation with PCI (from 20% to 25% [P = 0.004]). Heart failure rates declined substantially among STEMI and NSTEACS patients (from 21% to 12% [P = 0.0002], and from 13% to 4% [P < 0.0001], respectively) as did rates of hospital readmission for ischaemic heart disease at 6 months (from 23% to 9% [P = 0.0001], and from 24% to 15% [P = 0.0001], respectively)., Conclusions: From 2000 to 2007 in Australia and New Zealand, there was a fall in inhospital events and 6-month readmissions among patients admitted with ACS. This showed an association with improved uptake of guideline-recommended medical and interventional therapies. These data suggest an overall improvement in the quality of care offered to contemporary ACS patients in Australia and New Zealand.
- Published
- 2011
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