Abstract 6236: Potential Survival Gains in the Treatment of Myocardial Infarction in Australia
Background: Several clinical registries have documented the incomplete implementation of clinical evidence among myocardial infarction (MI) patients. Yet efforts to improve practice are resource intensive. We modeled the potential impact of complete implementation of current evidence compared with new innovations with respect mortality, recurrent events and costs.
Methods: Current use of proven therapies and base event rates for MI in Australia were prospectively assessed in a nationwide registry of 1744 patients and extrapolated to national data (47,000 MIs per year). Literature based estimates of treatment efficacy and hospital costs by diagnostic related code were used to estimate the number of deaths, recurrent MI and stroke events prevented, as well as dollars saved if there was to be complete application of guidelines. A “hypothetical” novel therapy providing a 20% 12-month reduction in events among optimally managed patients was also modeled.
Results: The observed 12-month base rates for death and recurrent MI/stroke for optimally managed MI patients in Australia were 4.4% and 9.7%, respectively. No reperfusion occurred in 30% of ST segment elevation MIs. Prescription of less than four guideline therapies occurred in 26% of patients. Compared with the in-hospital phase of care, better application of late therapies provided the greater absolute gains. In comparative terms a novel treatment reducing events by 20% would procure only a modest effect on overall mortality.
Conclusions: Potential gains from improved quality of MI care in Australia are likely to substantially out-weigh the benefits achieved though innovations, and may be a more efficient for improving outcome.