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Study of shortcomings in care wins $10,000 prize

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A study of the rates of guideline-recommended investigations and therapies for acute coronary syndrome (ACS) was awarded the annual MJA/MDA National Prize for Excellence in Medical Research at the AMA National Conference.

The paper, published in the Medical Journal of Australia, was entitled “Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study”, and looked at variations in the care of patients with acute coronary syndrome despite the presence of well-developed clinical guidelines.

Using data from local registries in Australia and New Zealand, the researchers found there was incomplete implementation of evidence-based guideline recommendations, with variations in care appearing to correlate with differences in clinical outcomes.

Geographical challenges, patient characteristics (including cultural diversity), health workforce and the health policy environment were identified as likely factors contributing to the uneven application of the guidelines.

This study set out to measure rates of guideline-recommended interventions and in-hospital clinical ACS events using public records and health network data from 478 sites and 4398 patients with suspected or confirmed ACS across Australia and New Zealand.

Of the 1436 patients with myocardial infarction (MI), 1019 (71 per cent) were treated with angiography, 610 (43 per cent) with percutaneous coronary intervention, and 116 (8 per cent) with coronary artery bypass grafting.

The in-hospital mortality rate was 4.5 per cent, and the recurrent MI rate was 5.1 per cent.

After adjusting for patient risk and other variables, significant variations in care and outcomes by hospital classification and jurisdiction were evident.

The authors identified variations in the application of the ACS evidence base and varying rates of in-hospital clinical events.

They concluded that “a focus on integrated clinical service delivery may provide greater translation of evidence to practice and improve ACS outcomes in Australia and New Zealand”.

The judges from the MJA’s Editorial Advisory Committee recognised that this research, conducted with robust and transparent methodology in a difficult real-world setting, contributes to the very important endeavour of improving the health of patients with suspected and confirmed acute coronary syndrome.

The prize was $10,000.