Myocardial Infarction In Australia Research Articles

Future burden of myocardial infarction in Australia: impact on health outcomes between 2019 and 2038.

Myocardial infarction (MI) remains a major health burden in Australia. Yet the future burden of MI has not been extensively studied for the Australian population. A multistate lifetable model was constructed to estimate the lifetime risk of MI and project the health burden of MI for the Australian population aged between 40 and 100 years over a 20-year period (2019-2028). Data for the model was primarily sourced from the Victorian linked dataset and supplemented with other national data. The lifetime risk of MI from age 40 years was estimated as 24.4% for males and 13.2% for females in 2018. From 2019-2038, 891 142 Australians were projected to develop incident MI. By 2038, the model estimated there would be 702 226 people with prevalent MI, 51 262 incident non-fatal MI and 3 717 incident fatal MI; these numbers represent a significant increase compared to the 2019 estimates, with a 27.0% (148 827), 62.0% (19 629), and 104.7% (1 901) rise, respectively. Projected years of life lived (YLL) (5% discount) accrued by the Australian population were 174 795 232 (84, 356 304 in males and 90 438 928 in females), with 7 657 423 YLL among people with MI (4 997 009 in males and 2 660 414 in females). The burden of MI was projected to increase between 2019 to 2038 in Australia. The outcomes of the model provide important information for decision-makers to prioritise population-wide prevention strategies to reduce the burden of MI.

Socioeconomic status and access to care in a universal health care system: The case of acute myocardial infarction in Australia

This paper examines the role of socioeconomic status (SES) in affecting access to care and the survival of acute myocardial infarction (AMI) patients in Australia's universal health care system. We jointly model the probabilities of patients being admitted to a catheterisation-capable hospital, receiving invasive coronary angiography (ICA), and surviving 30 days post discharge as a recursive system of probit equations. We further investigate the role of capacity and whether the access gap between SES groups widens when capacity becomes limited.Our study shows that SES plays a significant role in affecting the survival of AMI patients, both directly and indirectly through healthcare access. We find that socioeconomically disadvantaged patients are less likely to gain access to crucial services like catheterisation hospitals and ICA, which indirectly affects their survival probability in addition to the adverse direct impact of SES. While healthcare capacity showed no overall effect on access, its interplay with SES exacerbates the access disparity in situations of limited capacity. Our findings suggest that, to reduce inequality in health outcomes, public health strategy needs to focus not only on enhancing access but also addressing the direct consequences of SES.

Socioeconomic Status and Access to Care in a Universal Healthcare System: The Case of Acute Myocardial Infarction in Australia

Socioeconomic Status and Access to Care in a Universal Healthcare System: The Case of Acute Myocardial Infarction in Australia

Long term survival after acute myocardial infarction in Australia and New Zealand, 2009-2015: a population cohort study.

To assess long term survival and patient characteristics associated with survival following acute myocardial infarction (AMI) in Australia and New Zealand. Cohort study. All patients admitted with AMI (ICD-10-AM codes I21.0-I21.4) to all public and most private hospitals in Australia and New Zealand during 2009-2015. All-cause mortality up to seven years after an AMI. 239402 initial admissions with AMI were identified; the mean age of the patients was 69.3 years (SD, 14.3 years), 154287 were men (64.5%), and 64335 had ST-elevation myocardial infarction (STEMI; 26.9%). 7-year survival after AMI was 62.3% (STEMI, 70.8%; non-ST-elevation myocardial infarction [NSTEMI], 59.2%); survival exceeded 85% for people under 65 years of age, but was 17.4% for those aged 85 years or more. 120155 patients (50.2%) underwent revascularisation (STEMI, 72.2%; NSTEMI, 42.1%); 7-year survival exceeded 80% for patients in each group who underwent revascularisation, and was lower than 45% for those who did not. Being older (85 years or older v 18-54 years: adjusted hazard ratio [aHR], 10.6; 95% CI, 10.1-11.1) or a woman (aHR, 1.15; 95% CI, 1.13-1.17) were each associated with greater long term mortality during the study period, as was prior heart failure (aHR, 1.79; 95% CI, 1.76-1.83). Several non-cardiac conditions and geriatric syndromes common in these patients were independently associated with lower long term survival, including major and metastatic cancer, cirrhosis and end-stage liver disease, and dementia. AMI care in Australia and New Zealand is associated with high rates of long term survival; 7-year rates exceed 80% for patients under 65 years of age and for those who undergo revascularisation. Efforts to further improve survival should target patients with NSTEMI, who are often older and have several comorbid conditions, for whom revascularisation rates are low and survival after AMI poor.

ST-Elevation Acute Myocardial Infarction in Australia—Temporal Trends in Patient Management and Outcomes 1999–2016

Increased access to reperfusion for ST elevation myocardial infarction (STEMI) has contributed to reduced mortality internationally. We describe temporal trends in pre-hospital care, in-hospital management and outcomes of the STEMI population in Australia. Temporal trends with multiple regression analysis on the management and outcomes of STEMI patients enrolled across 46 Australian hospitals in the Australian cohort of the Global Registry of Acute Coronary Events (GRACE) and the Cooperative National Registry of Acute Coronary Care Guideline Adherence and Clinical Events (CONCORDANCE) between February 1999 and August 2016. 4,110 patients were treated for STEMI, mean age 62.5±13.7years (SD). The median door-to-balloon time of primary percutaneous coronary intervention (PPCI) decreased by 11minutes (p<0.01) although there was no increase in rates of PPCI (p=0.35). Access to non-primary PCI increased by 39% (p<0.01), provisioning of fibrinolysis decreased by 13% (p<0.01) and the median door-to-needle time of 35minutes remained unchanged (p=0.09). Prescription of medical therapies in-hospital remained high, and at discharge there was an increase in prescription of statins (p<0.01); aspirin including antiplatelets (p<0.01), beta blockers (p=0.023) and ACE/ARB (p=0.02). The occurrence of any in-hospital adverse clinical events declined by 78% (p<0.01) albeit, there was no reduction in mortality in-hospital (p=0.84) or within 6 months (p=0.81). Over time, there has been increased access to non-primary PCI; shorter door-to-balloon times for PPCI; less adverse events in-hospital and fewer readmissions for unplanned revascularisation without the realisation of reduced mortality in-hospital or at 6 months. CONCORDANCE Registry ACTRN: 12614000887673.

Long-Term Mortality Following Acute Myocardial Infarction in Australia and New Zealand: a Population-Wide Study

Long-Term Mortality Following Acute Myocardial Infarction in Australia and New Zealand: a Population-Wide Study

Post-Discharge Readmissions and Mortality Following Hospitalisation for Acute Myocardial Infarction in Australia and New Zealand

Post-Discharge Readmissions and Mortality Following Hospitalisation for Acute Myocardial Infarction in Australia and New Zealand

Predictors of cardiac rehabilitation attendance following primary percutaneous coronary intervention for ST-elevation myocardial infarction in Australia.

Cardiac rehabilitation is an important component of recovery and secondary prevention following urgent primary percutaneous coronary intervention. However, attendance and factors that predict participation by patients admitted with ST-elevation myocardial infarction remain unclear. This Australian study was conducted using a descriptive, comparative design. Consecutive patients (n = 246) at two hospitals were interviewed by telephone at four weeks and six months. Open-ended questions were used to assess cardiac rehabilitation attendance, sociodemographics, modifiable risk factors, clinical outcomes, and post-discharge health support. Post-discharge home visits at four weeks (odds ratio: 2.64, 95% confidence interval: 1.48-4.71) and at six months were associated with better cardiac rehabilitation attendance; more males participated at four weeks and at six months. The results suggest the need to integrate post-discharge health support with cardiac rehabilitation to facilitate recovery after primary percutaneous coronary intervention, particularly for females with ST-elevation myocardial infarction.

Abstract 214: Determinants of Cardiac Rehabilitation Referral Following Acute Myocardial Infarction In Australia

Background: Despite the known benefits of cardiac rehabilitation (CR) and widespread endorsement of its use, CR is vastly underutilised, with less than 30% of eligible patients participating in a CR program after a cardiac event. The current study assessed the factors independently associated with referral to CR following acute myocardial infarction (AMI). Methods: The CR referral rate and factors associated with referral were assessed among all consecutive patients undergoing coronary angiography for AMI and surviving to hospital discharge, attending South Australian public hospitals from January 2012 [[Unable to Display Character: &amp;#8211;]] December 2013. Data was maintained by the Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR ® CathPCI ® Registry. Results: Among 3,212 patients undergoing angiography for AMI, CR referral occurred in 1,530 patients (48%). Compared to patients without CR referral, these patients were younger (62±13 vs. 64±14, p&lt;0.01) and less likely to be female (25% vs. 34%, p&lt;0.01). Following age-adjusted analysis, the cardiovascular risk factors were similar between CR referral and non-CR referral patients including: diabetes (29% vs. 30%, p&gt;0.5), hypertension (61% vs. 64%, p&gt;0.5), and dyslipidaemia (59% vs. 60%, p&gt;0.5), but CR referral patients were more likely to be active smokers (40% vs. 33%, p&lt;0.01). CR referral patients were less likely to have additional comorbidities including current dialysis (0.9% vs. 2.2%, p&lt;0.01) and cerebrovascular disease (6.0% vs. 8.8%, p&lt;0.01). In multivariable analyses, factors associated with increased CR referral were (c statistic 0.68): presentation with ST-elevation MI (STEMI) (1.4, 1.2-1.7, p&lt;0.01), undergoing percutaneous coronary intervention (PCI) following angiography (1.6, 1.4-1.9, p&lt;0.01) and younger age (1.0, 0.98-1.0, p&lt;0.01). Prior CABG (0.6, 0.5-0.8, p&lt;0.01) and absence of significant coronary artery disease, defined by stenosis &lt;50%, (0.2, 0.1-0.3, p&lt;0.01) were associated with decreased referral. Lastly, secondary prevention therapies were more often prescribed at discharge in patients with CR referral compared to patients without referral including: aspirin (93% vs. 82%, p&lt;0.01), beta-blockers (64% vs. 61%, p&lt;0.05), statin (92% vs. 78%, p&lt;0.01), and ACE-inhibitor/angiotensin receptor blocker (84% vs. 74%, p&lt;0.01). Conclusion: This study highlights a significant disparity in cardiovascular care with approximately half of AMI patients not referred to CR, despite it being a key performance measure. STEMI presentation, younger age and undergoing PCI are associated with increased referral. Alarmingly, AMI patients not referred to CR are also less likely to receive other guideline-based therapies. Increased physician awareness about the benefits of CR is required and initiatives to overcome barriers to referral may improve the delivery of evidence-based care.

Nationwide Trends in the Incidence of Acute Myocardial Infarction in Australia, 1993–2010

Although most of the additional increases in coronary heart disease morbidity and mortality are estimated to occur outside developed regions such as North America and Europe, few nationwide studies have been published of acute myocardial infarction (MI) epidemiology from other regions. We thus sought to expand the global data regarding MI trends. Nationwide trends of incident MI, ST-segment elevation MI (STEMI), and non-ST-segment MI (non-STEMI) were analyzed during a 17-year period in Australia. We identified 714,262 hospitalizations for MI from 1993 to 2010, representing 331,871,389 person-years. During the study period, the age- and gender-adjusted incidence of all MIs increased from 215 to 251 cases per 100,000 person-years, a relative increase of 76% (p <0.0001 for trend). The adjusted incidence of STEMI decreased from 147 to 70 cases per 100,000 person-years, a relative decrease of 30% (p <0.0001 for trend). In contrast, the adjusted incidence of non-STEMI increased from 67 to 182 cases per 100,000 person-years, a relative increase of 315% (p<0.0001 for trend). Age-specific analyses suggested that statistically significant increases in MI incidence were present in those aged <50 and ≥80 years. In conclusion, although it has previously been suggested that declining trends in MI incidence in North American and European reports might be generalizable given the seemingly consistent observations thus far, the present results highlight the possibility that other global populations might have less favorable trends. The incidence of MI in Australia might not be decreasing as rapidly as thatseen in other regions and requires additional exploration.

Comparative Effectiveness of Population Interventions to Improve Access to Reperfusion for ST-Segment–Elevation Myocardial Infarction in Australia

Improving timely access to reperfusion is a major goal of ST-segment-elevation myocardial infarction care. We sought to compare the population impact of interventions proposed to improve timely access to reperfusion therapy in Australia. Australian hospitals, population, and road network data were integrated using Geographical Information Systems. Hospitals were classified into those that provided primary percutaneous coronary intervention (PPCI) or fibrinolysis. Population impact of interventions proposed to improve timely access to reperfusion (PPCI, fibrinolysis, or both) were modeled and compared. Timely access to reperfusion was defined as the proportion of the population capable of reaching a fibrinolysis facility ≤60 minutes or a PPCI facility ≤120 minutes from emergency medical services activation. The majority (93.2%) of the Australian population has timely access to reperfusion, mainly (53%) through fibrinolysis. Only 40.2% of the population had timely access to PPCI, and access to PPCI services is particularly limited in regional and nonexistent in remote areas. Optimizing the emergency medical services' response or increasing PPCI services resulted in marginal improvement in timely access (1.8% and 3.7%, respectively). Direct transport to PPCI facilities and interhospital transfer for PPCI improves timely access to PPCI for 19.4% and 23.5% of the population, respectively. Prehospital fibrinolysis markedly improved access to timely reperfusion in regional and remote Australia. Significant gaps in timely provision of reperfusion remain in Australia. Systematic implementation of changes in service delivery has potential to improve timely access to PPCI for a majority of the population and improve access to fibrinolysis to those living in regional and remote areas.

Reperfusion therapy in the acute management of ST‐segment‐elevation myocardial infarction in Australia: findings from the ACACIA Registry

Reperfusion therapy in the acute management of ST‐segment‐elevation myocardial infarction in Australia: findings from the ACACIA Registry

Reperfusion therapy in the acute management of ST‐segment‐elevation myocardial infarction in Australia: findings from the ACACIA registry

To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia. Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. In hospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.

Reasons and Predictors for Choosing Ambulance Transportation by Patients with Acute Myocardial Infarction in Australia

Reasons and Predictors for Choosing Ambulance Transportation by Patients with Acute Myocardial Infarction in Australia

The Economic Costs of Schizophrenia

The direct and indirect costs associated with schizophrenia in Australia were calculated using the incidence approach and compared with similar costings of myocardial infarction in Australia and the United States. In Australia schizophrenia affects one-twelfth as many people as does myocardial infarction, yet costs half as much. This is because the stream of costs associated with each case of schizophrenia is six times the stream of costs associated with myocardial infarction. To illustrate the utility of this costing approach, the information was used to estimate the cost-benefit ratio likely to follow the introduction of social intervention strategies. The information also showed that Australian support for research in schizophrenia is inadequate when compared with that for myocardial infarction and quite out of proportion to the cost of schizophrenia to the community.