Patients admitted with an acute coronary syndrome (ACS) in New Zealand in 2007: results of a second comprehensive nationwide audit and a comparison with the first audit from 2002.
OBJECTIVE
To audit all patients admitted to a New Zealand (NZ) Hospital with an acute coronary syndrome (ACS) over a 14-day period, to assess their number, presentation type and patient management during the hospital admission and at discharge. To compare patient management in 2007 with the 1st NZ Cardiac Society ACS Audit from 2002.


METHODS
We updated the established NZ ACS Audit group of 36 hospitals to 39 hospitals now admitting ACS patients across New Zealand. A comprehensive data form was used to record individual patient information for all patients admitted between 00.00 hours on 14 May 2007 to 24.00 hours on 27 May 2007.


RESULTS
1003 patients, 9% more than in 2002 (n=930), were admitted with a suspected or definite ACS: 8% with a ST-segment-elevation myocardial infarction (STEMI), 41% with a non-STEMI (NSTEMI), 33% with unstable angina pectoris (UAP), and 17% with another cardiac or medical condition. In 2007 non-invasive risk stratification following presentation remained similar to 2002 and was suboptimal: exercise treadmill tests (21% vs 20%, p=0.62), echocardiograms (19% vs 20%, p=0.85). An increase in utilisation of coronary angiography was noted (32% vs 21%, p<0.0001). In hospital revascularisation rates remained low in patients with diagnosed ACS (n=828): STEMI (45%), NSTEMI (23%) and UAP (7.3%). In comparison to 2002, changes were noted in revascularisation techniques with percutaneous coronary intervention (PCI) performed in 19% vs 7% (p<0.0001). The use of coronary artery bypass grafting (CABG) remained extremely low: 2.8% vs 3.5% (p=0.20). The use of hospital and discharge medication of proven benefit was also limited.


CONCLUSIONS
A collaborative group of clinicians and nurses has performed a second nationwide audit of ACS patients. Despite a small increase in access to cardiac angiography, guideline recommended risk stratification following the index suspected ACS admission with a treadmill test or cardiac angiogram occurred in only 1 in 2 (48%) patients. Furthermore, in patients with a definite ACS, levels of revascularisation are low. (PCI 19%, CABG 2.8%). These aspects of care remain of significant concern and have not substantially changed in 5 years. There remains an urgent need to develop a comprehensive national strategy to improve all aspects of ACS patient management.
Ellis
Chris
C
Cardiology Department, Green Lane CVS Services, Level 3, Auckland City Hospital, Grafton, Auckland 1023, New Zealand. chrise@adhb.govt.nz
Gamble
Greg
G
Hamer
Andrew
A
Williams
Michael
M
Matsis
Philip
P
Elliott
John
J
Devlin
Gerard
G
Richards
Mark
M
White
Harvey
H
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000289:Admitting Department, Hospital / Q000266:history / Q000706:statistics & numerical data*; D000368:Aged; D001315:Australia; D017023:Coronary Angiography / Q000706:statistics & numerical data; D005060:Europe; D005080:Exercise Test; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006297:Health Services Accessibility / Q000266:history / Q000706:statistics & numerical data*; D049674:History, 21st Century; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000266:history / Q000706:statistics & numerical data*; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D009520:New Zealand; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D005343:Fibrinolytic Agents