Both incidence and prevalence of ischaemic heart disease are declining in parallel: a national data-linkage study in New Zealand (ANZACS-QI 52).

AIMS: To examine trends in ischaemic heart disease (IHD) incidence and prevalence in New Zealand from 2005 to 2016, using comprehensive linked national hospitalization and mortality data as proxy measures of all significant events. METHODS AND RESULTS: Incident and prevalent cases of IHD in people aged ≥25 years were identified using individual patient-linkage of routinely collected ICD-10-coded hospitalization and mortality data. Incidence rates and prevalence proportions were calculated by sex and age group and then age-standardized to the 2016 New Zealand population. Ischaemic heart disease incidence and prevalence declined in men and women in all age groups. The average annual rate of decline in age-standardized IHD incidence was 3.3% for women and 2.7% for men, and the rate of decline in age-standardized IHD prevalence was 3.2% for women and 2.2% for men. Despite a 17% increase in the New Zealand population aged 25 years and over during the study period, the total number of people living with IHD also decreased, particularly in those aged 65 years and older. CONCLUSION: In contrast to observations from other countries, where IHD incidence but not IHD prevalence has been falling, declining IHD incidence in New Zealand in recent decades is now mirrored by declining IHD prevalence.

Nationwide dispensing of cardioprotective medications during the first year following acute coronary syndrome (ANZACS-QI 56).

AIM: A number of evidence-based medications are recommended following an acute coronary syndrome (ACS), including statins, antithrombotics (antiplatelet and/or anticoagulants), a beta-blocker and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACE-I/ARB). This study aimed to describe the dispensing of the cardioprotective medications in the first year following an ACS hospitalisation in New Zealand and how this varies according to age, sex and type of coronary intervention. METHOD: National hospitalisation data was used to identify all New Zealand residents aged 35-79 years who were discharged from hospital in the years 2013/14 with a primary discharge diagnosis of ACS. Using anonymous linkage to national pharmaceutical dispensing and mortality datasets, the dispensing of each group of medications was examined in survivors of quarters one, two and four of the first year post discharge. RESULTS: There were 14,496 patients; mean age was 63.4 years and 68.8% were male. Dispensing of medications in survivors steadily fell across quarters one, two and four: 90.8%, 82.1% and 78.8% of patients were dispensed statins; 90.6%, 79.8% and 78.1% were dispensed aspirin; 82.7%, 72.6% and 70.0% were dispensed beta-blockers; 69.6%, 62.7% and 61.3% were dispensed ACE-I/ARB; 67.7%, 53.6% and 40.4% were dispensed a P2Y12 inhibitor; and 68.6%, 53.0% and 40.7% were dispensed a combination of two or more antithrombotics. CONCLUSION: Cardioprotective medication dispensing was lower than would have been the case if the current ACS guidelines were followed. The greatest decrease in dispensing occurred between quarter one and quarter two, which highlights a potentially important period for targeted interventions to improve adherence.

Acute coronary syndrome registry enrolment status: differences in patient characteristics and outcomes and implications for registry data use (ANZACS-QI 36).

AIMS: Clinical registry-derived data are widely used to represent patient populations. In New Zealand (NZ), a national registry-the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry-aims to include all patients undergoing coronary angiography; other acute coronary syndrome (ACS) patients are also registered but without complete capture. This study compares national hospitalization data of all first-time ACS admissions in NZ with patients in the ANZACS-QI registry, to investigate the use of clinical registry-derived data in research and in assessing clinical care. METHODS AND RESULTS: Patients admitted with first-time ACS in the NZ National Hospitalisation Dataset between 1 January 2015 and 31 December 2016 were included. Clinical characteristics and time to 12-month clinical outcomes were compared between patients captured and not-captured in the registry. A total of 16 569 patients were admitted with first-time ACS, median age 69 years, 61% male; 60% (n = 9918) were enrolled in ANZACS-QI. Registry-captured patients were younger, more often male, and with a lower comorbidity burden than non-captured patients. Overall, 16% patients died within 12 months, 15% experienced a non-fatal cardiovascular (CV) readmission, and 28% either died or were readmitted. Patients not captured in the registry were more than twice as likely to have experienced death or a non-fatal CV readmission within 12 months as captured patients. CONCLUSIONS: First-time ACS patients captured in the ANZACS-QI registry had very different clinical characteristics and outcomes than those not captured. Cardiovascular registry-derived data are dependent on registry design and may not be representative of the wider patient population; this must be considered when using registry-derived data.

Trends in ischaemic heart disease: patterns of hospitalisation and mortality rates differ by ethnicity (ANZACS-QI 21).

AIM: To examine trends in ischaemic heart disease (IHD) events by ethnicity. METHODS: All IHD deaths and hospitalisations from 2006-2015 were identified using individual-linkage of national hospitalisation and mortality data. Age-standardised IHD rates and average annual age-adjusted percent changes were estimated by ethnic group. Ratios of non-fatal to fatal events were calculated by dividing age-standardised hospitalisation by death rates. RESULTS: IHD mortality rates declined by 3.1-5.4% per year for most groups, except Pacific women, who experienced a non-significant decline of 1.3% per year. IHD hospitalisation rates declined significantly by 3.6-8.8% per year in all groups. IHD mortality rates were highest in Maori and Pacific people, but hospitalisation rates highest in Indians. Indians also had the highest ratio of hospitalisations to deaths. For every person who died from IHD in 2014/15, 7-8 Indians, but only 3-4 Maori or Pacific people, were hospitalised with IHD. CONCLUSION: Fatal and non-fatal IHD rates are declining in all groups, but Maori and Pacific people have disproportionately high rates of IHD mortality. The much lower ratio of IHD hospitalisations to deaths among Maori and Pacific people compared to others suggests there are still important barriers to preventive interventions and acute care for Maori and Pacific men and women.