title: Management and outcomes of patients with acute coronary syndromes in Australia and New Zealand, 2000-2007.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.forename: Vincent
authors.initials: V
authors.lastname: Chow
authors.forename: Shruti
authors.initials: S
authors.lastname: Kapila
authors.forename: Craig
authors.initials: C
authors.lastname: Juergens
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: John
authors.initials: J
authors.lastname: Elliott
authors.forename: Jeff
authors.initials: J
authors.lastname: Lefkowitz
authors.forename: David B
authors.initials: DB
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D006333:Heart Failure / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data / Q000639:trends; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012042:Registries; D020521:Stroke / Q000453:epidemiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin