SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals): a protocol for a population-wide cohort study of outcomes of hospital care

First published on 20 August 2020.INTRODUCTION:Despite global concerns about the safety and quality of health care, population-wide studies of hospital outcomes are uncommon. The SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals) study seeks to estimate the incidence of serious adverse events, mortality, unplanned rehospitalisations and direct costs following hospital encounters using nationwide data, and to assess the variation and trends in these outcomes. METHODS AND ANALYSIS:SAFER Hospitals is a cohort study with retrospective and prospective components. The retrospective component uses data from 2012 to 2018 on all hospitalised patients age ≥18 years included in each State and Territories' Admitted Patient Collections. These routinely collected datasets record every hospital encounter from all public and most private hospitals using a standardised set of variables including patient demographics, primary and secondary diagnoses, procedures and patient status at discharge. The study outcomes are deaths, adverse events, readmissions and emergency care visits. Hospitalisation data will be linked to subsequent hospitalisations and each region's Emergency Department Data Collections and Death Registries to assess readmissions, emergency care encounters and deaths after discharge. Direct hospital costs associated with adverse outcomes will be estimated using data from the National Cost Data Collection. Variation in these outcomes among hospitals will be assessed adjusting for differences in hospitals' case-mix. The prospective component of the study will evaluate the temporal change in outcomes every 4 years from 2019 until 2030. ETHICS AND DISSEMINATION:Human Research Ethics Committees of the respective Australian states and territories provided ethical approval to conduct this study. A waiver of informed consent was granted for the use of de-identified patient data. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journals.Isuru Ranasinghe, Sadia Hossain, Anna Ali, Dennis Horton, Robert JT Adams, Bernadette Aliprandi-Costa, Christina Bertilone, Gustavo Carneiro, Martin Gallagher, Steven Guthridge, Billingsley Kaambwa, Sradha Kotwal, Gerry O'Callaghan, Ian A Scott, Renuka Visvanathan, Richard J Woodma

Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand

OBJECTIVE: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. METHODS: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. RESULTS: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. CONCLUSIONS: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.Julie Redfern, Karice Hyun, Derek P Chew, Carolyn Astley, Clara Chow, Bernadette Aliprandi-Costa, Tegwen Howell, Bridie Carr, Karen Lintern, Isuru Ranasinghe, Kellie Nallaiah, Fiona Turnbull, Cate Ferry, Chris Hammett, Chris J Ellis, John French, David Brieger, Tom Briff

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

© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Background: 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. Methods: 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. Results: 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 11 minutes (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 35 minutes 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). Conclusions: 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. Trial registration: CONCORDANCE Registry ACTRN: 12614000887673

Declining total cholesterol levels and increasing lipid lowering therapy use at presentation in patients with acute coronary syndrome.

Abstract from the Cardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meeting, 8-11 Aug 2013, Gold Coas

The Design and Rationale of the Australian Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events (CONCORDANCE)

Abstract not available.B. Aliprandi-Costa, I. Ranasinghe, F. Turnbull, A. Brown, L. Kritharides, A. Patel, D. Chew, D.Walters, J. Rankin, M. Ilton, I. Meredith, A. Cass and D. Briege

Cardiac services for care of suspected acute coronary syndromes in Australia and New Zealand hospitals

Abstract 18319Isuru Ranasinghe, Carolyn Astley, Bernadette Aliprandi-Costa, Derek Chew, Christopher J Ellis, Christopher J Hammett, Tom G Briffa, Tegwen E Howell, Karen J Lintern, Hella Parker, Bridie Carr, Greg D Gamble, Rosanna Tavella, Julie Redfern, John French, David Briege

Evidence-based care in a population with chronic kidney disease and acute coronary syndrome. Findings from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE)

BackgroundAcute coronary syndrome (ACS) guidelines recommend that patients with chronic kidney disease (CKD) be offered the same therapies as other high-risk ACS patients with normal renal function. Our objective was to describe the gaps in evidence-based care offered to patients with ACS and concomitant CKD.MethodsPatients presenting to 41 Australian hospitals with suspected ACS were stratified by presence of CKD (glomerular filtration rate &lt;60 mL/min). Receipt of evidence-based care including, coronary angiography (CA), evidence-based discharge medications (EBMs), and cardiac rehabilitation (CR) referral, were compared between patients with and without CKD. Hospital and clinical factors that predicted receipt of care were determined using multilevel multivariable stepwise logistic regression models.ResultsOf the 4,778 patients admitted with suspected ACS, 1,227 had CKD. On univariate analyses, patients with CKD were less likely to undergo CA (59.1% vs 85.0%, P &lt; .0001) or receive EBM (69.4% vs 78.7%, P &lt; .0001), or were offered CR (49.5% vs 68.0%, P &lt; .0001). After adjusting for patient characteristics and clustering by hospital, CKD remained an independent predictor of not undergoing CA only (odds ratio 0.48, 95% CI 0.37-0.61). Within the CKD cohort, presenting to a hospital with a catheterization laboratory was the strongest predictor of undergoing CA (odds ratio 3.07, 95% CI 1.91-4.93).ConclusionThe presence of CKD independently predicts failure to undergo CA but not failure to receive EBM or CR, which is predicted by comorbidities. Among the CKD population, performance of CA is largely determined by admission to a catheterization capable hospital. Targeting these patients through standardization of care across institutions offers opportunities to improve outcomes in this high-risk population