Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia

Isuru Ranasinghe, Fiona Turnbull, Andrew Tonkin, Robyn Clark, Neil COFFEE, David Brieger

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background-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. Methods and Results-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. Conclusions-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
Original languageEnglish
Pages (from-to)429-436
Number of pages8
JournalCirculation. Cardiovascular Quality and Outcomes
Volume5
Issue number4
DOIs
Publication statusPublished - 2012
Externally publishedYes

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Percutaneous Coronary Intervention
Reperfusion
Fibrinolysis
Population
Emergency Medical Services
ST Elevation Myocardial Infarction
Geographic Information Systems

Cite this

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title = "Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia",
abstract = "Background-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. Methods and Results-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. Conclusions-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",
author = "Isuru Ranasinghe and Fiona Turnbull and Andrew Tonkin and Robyn Clark and Neil COFFEE and David Brieger",
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Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia. / Ranasinghe, Isuru; Turnbull, Fiona; Tonkin, Andrew; Clark, Robyn; COFFEE, Neil; Brieger, David.

In: Circulation. Cardiovascular Quality and Outcomes, Vol. 5, No. 4, 2012, p. 429-436.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia

AU - Ranasinghe, Isuru

AU - Turnbull, Fiona

AU - Tonkin, Andrew

AU - Clark, Robyn

AU - COFFEE, Neil

AU - Brieger, David

PY - 2012

Y1 - 2012

N2 - Background-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. Methods and Results-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. Conclusions-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

AB - Background-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. Methods and Results-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. Conclusions-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

U2 - 10.1161/CIRCOUTCOMES.112.965111

DO - 10.1161/CIRCOUTCOMES.112.965111

M3 - Article

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SP - 429

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JO - Circulation. Cardiovascular Quality and Outcomes

JF - Circulation. Cardiovascular Quality and Outcomes

SN - 1941-7705

IS - 4

ER -