Objectives Characterisation of trends in acute coronary syndrome (ACS) outcomes are critical to informing clinical practice and quality improvement, but there are few recent population studies for ACS. We reviewed the recent trends in the outcomes of ACS in New Zealand (NZ).
Methods All patients with ACS admitted to NZ public hospitals in 2006–2016 were identified from hospital discharge records, and their first ACS hospitalisations per year extracted for analysis. Thirty-day and 1-year death, myocardial infarction, stroke, heart failure and bleeding rates were calculated for each calendar year. Trends in outcome rates were assessed using generalised linear mixed models.
Results Total annual ACS hospitalisations decreased from 685 to 424 per 100 000. Using first patient hospitalisations per year (n=1 55 060), we found significant annual declines in all major outcomes except for non-cardiovascular deaths. All-cause mortality fell from 10.5% to 9.1% at 30 days (adjusted OR 0.985 per year change, p<0.001) and from 21.8% to 18.7% at 1 year (OR=0.994, p=0.016). This was related to significant decreases in cardiovascular death at both time points (OR=0.982 and 0.987, respectively, p<0.001), outweighing a slight increase in non-cardiovascular death at 1 year (OR=1.009, p=0.014). One-year rates of myocardial infarction, heart failure, stroke and bleeding rates all decreased significantly over time.
Conclusion ACS outcomes including all-cause mortality, cardiovascular death, myocardial infarction, stroke, heart failure and bleeding at 30 days and 1 year improved over the last decade in NZ, reflecting successful implementation and advances in prevention, medical and invasive management in ACS over time.
- acute coronary syndromes
- coronary artery disease
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Contributors TKMW, CG, YJ, CB, RTJ and AJK planned the study. TKMW, CG, YJ, VS and AJK were involved in the methodology. All authors were involved in the interpretation of the study. TKMW, CG, YJ and AJK prepared the first draft. All authors revised the manuscript and approved its submission.
Funding This work was supported by the New Zealand Health Research Council, Wellington (grant number 11/800—CG and AJK); and the National Heart Foundation of New Zealand, Auckland (grant number 1803—TKMW). The ANZACS-QI programme is funded by the NZ Ministry of Health.
Disclaimer Researchers are independent from funders, and the funders had no role in the study design, collection, analysis or interpretation of data.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval This research was performed as part of the VIEW-ANZACS-QI research programme. Ethics approval was obtained from the Northern Region Ethics Committee (AKY/03/12/314) and Multi-Region Ethics Committee (MEC/01/19/EXP and MEC/11/EXP/078). All data were anonymised in the analyses so individual patient consent was not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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