title: Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry.
abstract: The aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) (NCT01171404).
  
  
  
  EPICOR was a prospective, multinational, observational study that enrolled 10 568 ACS survivors from 555 hospitals in 20 countries in Europe and Latin America, between September 2010 and March 2011. HCRU was evaluated in patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), with or without a history of cardiovascular disease (CVD). Multivariable analysis was performed to determine factors that affected resource use.
  
  
  
  Before hospitalisation, more patients with STEMI than with NSTE-ACS had their first ECG (44.1% vs 36.4%, p<0.0001) and received antithrombotic medication (26.6% vs 15.2%, p<0.0001). Patients with NSTE-ACS with prior CVD were less likely than those without to be catheterised (73.1% vs 82.8%, p<0.0001). More patients with STEMI than with NSTE-ACS had percutaneous coronary intervention (77.1% vs 54.9%, p<0.0001), but fewer underwent coronary artery bypass grafting (1.2% vs 3.7%, p<0.0001). Multivariable analysis showed that resource use, including length of hospital stay and coronary revascularisation, was significantly influenced by multiple factors, including ACS type, site characteristics and region (all p≤0.05).
  
  
  
  In this large-scale, real-life study, findings were generally in line with clinical logic, although site characteristics and region still significantly affected resource use. Moreover, and unexpectedly, resource use tended to be slightly higher in patients without a history of CVD.
  
  
  
  NCT01171404 (ClinicalTrials.gov).
authors.affiliation: Department of Public Health , I-CHER Interuniversity Centre for Health Economics Research , Ghent University , Ghent , Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Département de Cardiologie , Hôpital Européen Georges Pompidou & Université René Descartes , Paris , France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Department of Cardiovascular Medicine , University Hospitals Leuven , Leuven , Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.affiliation: London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: Medical Department , AstraZeneca France , Rueil Malmaison Cedex , France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Licour
authors.affiliation: Observational Research Centre, Payer & Real World Evidence, AstraZeneca , Madrid , Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares (CNIC); Cardiology Department, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre; Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno