title: Comparison of the management and in-hospital outcomes of acute coronary syndrome patients in Australia and New Zealand: results from the binational SNAPSHOT acute coronary syndrome 2012 audit.
abstract: OBJECTIVE
  We aimed to assess differences in patient management, and outcomes, of Australian and New Zealand patients admitted with a suspected or confirmed acute coronary syndrome (ACS).
  
  
  METHODS
  We used comprehensive data from the binational Australia and New Zealand ACS 'SNAPSHOT' audit, acquired on individual patients admitted between 00.00 h on 14 May 2012 to 24.00 h on 27 May 2012.
  
  
  RESULTS
  There were 4387 patient admissions, 3381 (77%) in Australia and 1006 (23%) in New Zealand; Australian patients were slightly younger (67 vs 69 years, P = 0.0044). Of the 2356 patients with confirmed ACS, Australian patients were at a lower cardiovascular risk with a lower median Global Registry Acute Coronary Events score (147 vs 154 P = 0.0008), but as likely to receive an invasive coronary angiogram (58% vs 54%, P = 0.082), or revascularisation with percutaneous coronary intervention (32% vs 31%, P = 0.92) or coronary artery bypass graft surgery (7.0% vs 5.6%, P = 0.32). Of the 1937 non-segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP) patients, Australian patients had a shorter time to angiography (46 h vs 67 h, P < 0.0001). However, at discharge, Australian NSTEMI/UAP survivors were less likely to receive aspirin (84% vs 89%, P = 0.0079, a second anti-platelet agent (57% vs 63%, P = 0.050) or a beta blocker (67% vs 77%, P = 0.0002). In-hospital death rates were not different (2.7% vs 3.2%, P = 0.55) between Australia and New Zealand.
  
  
  CONCLUSIONS
  Overall more similarities were seen, than differences, in the management of suspected or confirmed ACS patients between Australia and New Zealand. However, in several management areas, both countries could improve the service delivery to this high-risk patient group.
authors.affiliation: Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Ellis
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Hammett
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Ranasinghe
authors.affiliation: Department of Cardiology, Liverpool Hospital, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: French
authors.affiliation: School of Population Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Briffa
authors.affiliation: Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Cardiology Department, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Elliott
authors.affiliation: Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Lefkovitz
authors.affiliation: Department of Cardiology, Concord Hospital, Sydney, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.affiliation: Statewide Systems Strategy, SA Health, Adelaide, South Australia, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Astley
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Redfern
authors.affiliation: Clinical Access and Redesign Unit, Queensland Department of Health, Brisbane, Queensland, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Howell
authors.affiliation: Agency for Clinical Innovation, Sydney, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Carr
authors.affiliation: Agency for Clinical Innovation, Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Lintern
authors.affiliation: Health Networks Branch, Department of Health of Western Australia, Perth, Western Australia, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Bloomer
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Farshid
authors.affiliation: Cardiology Department, Wellington Hospital, Wellington, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Matsis
authors.affiliation: Department of Cardiology, Nelson Marlborough District Health Board, Nelson, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Hamer
authors.affiliation: Cardiology Department, Dunedin Hospital, Dunedin, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.affiliation: The Christchurch Heart Institute, Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Troughton
authors.affiliation: Department of Cardiovascular Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Horsfall
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Hyun
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: Gamble
authors.affiliation: Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: H
authors.initials: H
authors.lastname: White
authors.affiliation: Department of Cardiology, Concord Hospital, Sydney, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Brieger
authors.affiliation: Department of Cardiovascular Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Chew
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D000368:Aged; D001315:Australia / Q000453:epidemiology; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010351:Patient Discharge; D015996:Survival Rate
keywords: acute coronary syndrome; audit; cardiology