title: Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study.
abstract: OBJECTIVE
  To characterise management of suspected acute coronary syndrome (ACS) in Australia and New Zealand, and to assess the application of recommended therapies according to published guidelines.
  
  
  METHODS
  All patients hospitalised with suspected or confirmed ACS between 14 and 27 May 2012 were enrolled from participating sites in Australia and New Zealand, which were identified through public records and health networks. Descriptive and logistic regression analysis was performed.
  
  
  METHODS
  Rates of guideline-recommended investigations and therapies, and inhospital clinical events (death, new or recurrent myocardial infarction [MI], stroke, cardiac arrest and worsening congestive heart failure).
  
  
  RESULTS
  Of 478 sites that gained ethics approval to participate, 286 sites provided data on 4398 patients with suspected or confirmed ACS. Patients' mean age was 67 2013s (SD, 15 2013s), 40% were women, and the median Global Registry of Acute Coronary Events (GRACE) risk score was 119 (interquartile range, 96-144). Most patients (66%) presented to principal referral hospitals. MI was diagnosed in 1436 patients (33%), unstable angina or likely ischaemic chest pain in 929 (21%), unlikely ischaemic chest pain in 1196 (27%), and 837 patients (19%) had other diagnoses not due to ACS. Of the patients with MI, 1019 (71%) were treated with angiography, 610 (43%) with percutaneous coronary intervention and 116 (8%) with coronary artery bypass grafting. Invasive management was less likely with increasing patient risk (GRACE score < 100, 90.1% v 101-150, 81.3% v 151-200, 49.4% v > 200, 36.1%; P < 0.001). The inhospital mortality rate was 4.5% and recurrent MI rate was 5.1%. After adjusting for patient risk and other variables, significant variations in care and outcomes by hospital classification and jurisdiction were evident.
  
  
  CONCLUSIONS
  This first comprehensive combined Australia and New Zealand audit of ACS care identified variations in the application of the ACS evidence base and varying rates of inhospital clinical events. A focus on integrated clinical service delivery may provide greater translation of evidence to practice and improve ACS outcomes in Australia and New Zealand.
authors.affiliation: Department of Cardiovascular Medicine, Flinders University, Adelaide, SA. Derek.Chew@flinders.edu.au
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.forename: John
authors.initials: J
authors.lastname: French
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammett
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Ellis
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.forename: Bernadette J
authors.initials: BJ
authors.lastname: Aliprandi-Costa
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Astley
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Turnbull
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.forename: Bridie
authors.initials: B
authors.lastname: Carr
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Lintern
authors.forename: Tegwen E J
authors.initials: TE
authors.lastname: Howell
authors.forename: Hella
authors.initials: H
authors.lastname: Parker
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tavella
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Bloomer
authors.forename: Karice K
authors.initials: KK
authors.lastname: Hyun
authors.forename: David B
authors.initials: DB
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D001315:Australia; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D004562:Electrocardiography / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009520:New Zealand; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome