Advertisement
Heart, Lung and Circulation

Impact of Reducing Pre-Hospital Delay in Response to Heart Attack Symptoms in Australia

Published:August 25, 2018DOI:https://doi.org/10.1016/j.hlc.2018.07.018

      Background

      This research estimates the broader socioeconomic impacts of reducing pre-hospital delay times across Australia in patients with heart attack symptoms.

      Methods

      A cost benefit analysis (CBA) was undertaken to demonstrate the costs and benefits of a public awareness/education campaign to reduce pre-hospital delay time from 5.2 hours (Base Case) to 4.1 hours (Scenario 1) and 2.0 hours (Scenario 2). All assumptions underlying the CBA are supported by academic literature.
      Financial impacts considered include campaign/public education costs, direct inpatient costs and long-term health care costs. Socioeconomic impacts considered include burden of disease, productivity losses, informal care costs and net deadweight loss.

      Results

      The campaign is expected to generate an additional net benefit of $41.2–139.1 million in comparison to the Base Case, resulting in a benefit cost ratio (BCR) of 3.23–5.06. Disability Adjusted Life Years (DALYs) reduced by 6,046-7,575 years.

      Conclusion

      This research illustrates that an investment in public awareness/education campaign can generate considerable benefits, more than offsetting the costs associated with the campaign and keeping people living longer such as ongoing health care costs. However, significant effort, supplementary strategies and sustained investment will be required to ensure the impact and benefit is sustained over the long term.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Australian Bureau of Statistics. 4364.0.55.001 – National health survey: 2014-15. Canberra: Australian Bureau of Statistics, 2015.

      2. Australian Bureau of Statistics. 3303.0 – Causes of death, Australia, 2016. Canberra: Australian Bureau of Statistics, 2017.

        • Berger A.
        • Schulman K.
        • Gersh B.
        • Pirzada S.
        • Breall J.
        • Johnson A.
        • et al.
        Primary coronary angioplasty vs thrombolysis for the management of acute myocardial infarction in elderly patients.
        JAMA. 1999; 282: 341-348
        • Finn J.
        • Nick Bett J.
        • Shilton T.
        • Cunningham C.
        • Thompson P.
        Patient delay in responding to symptoms of possible heart attack: can we reduce time to care?.
        MJA. 2007; 185: 293-298
        • GISSI. Avoidable Delay Study Group
        Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. A GISSI-generated study.
        Arch Intern Med. 1995; 155: 1481-1488
        • Bray J.
        • Stub D.
        • Ngu P.
        • Cartledge S.
        • Straney L.
        • Stewart M.
        • et al.
        Mass media campaigns’ influence on prehospital behavior for acute coronary syndromes: an evaluation of the Australian Heart Foundation’s Warning Signs campaign.
        J Am Heart Assoc. 2015; 4e001927
        • Francone M.
        • Bucciarelli-Ducci C.
        • Carbone I.
        • Canali E.
        • Scardala R.
        • Calabrese F.
        • et al.
        Impact of primary coronary angioplasty delay on myocardial salvage, infarct size, and microvascular damage in patients with ST-segment elevation myocardial infarction: insight from cardiovascular magnetic resonance.
        J Am Coll Cardiol. 2009; 54: 2145-2153
      3. Australian Institute of Health and Welfare. Australian hospital statistics 2009-0 and 2011-12 (Health services series no. 40 and 50. Cat. No. HSE 107 and 134). Canberra: Australian Institute of Health and Welfare, 2011.

        • Department of Treasury and Finance
        Economic evaluation for business cases: technical guidelines.
        Department of Treasury and Finance, Melbourne2013
        • Boersma E.
        • Maas A.
        • Deckers J.
        • Simoons M.
        Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour.
        Lancet. 1996; 348: 771-775
        • Dharmarajan K.
        • Hsieh A.
        • Tulkarni V.
        • Lin Z.
        • Ross J.
        • Horwitz L.
        • et al.
        Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study.
        BMJ. 2015; 350: h411
        • Deloitte Access Economics
        ACS in perspective: the importance of secondary prevention.
        2011 (Available at: https://www2.deloitte.com/content/dam/Deloitte/au/Documents/Economics/deloitte-au-economics-acs-perspective-importance-secondary-prevention-011111.pdf [Accessed 02.06.16])
      4. Australian Bureau of Statistics. 3302.0.55.001 – Life tables, states, territories and Australia, 2013–2015. Canberra: Australian Bureau of Statistics, 2016.

        • Australian Institute of Health and Welfare
        The burden of disease and injury in Australia 2003 (Cat. No. PHE 82).
        Australian Institute of Health and Welfare, Canberra2007
        • Australian Bureau of Statistics
        6202.0 Labour Force Australia.
        Australian Bureau of Statistics, Canberra2016
      5. Australian Bureau of Statistics. 6302.0 Average weekly earnings, Australia. Canberra: Australian Bureau of Statistics. Canberra: Australian Bureau of Statistics, 2016.

        • European Society of Cardiology
        One-third of heart failure patients do not return to work.
        2016 (Available at: https://www.escardio.org/The-ESC/Press-Office/Press-releases/one-third-of-heart-failure-patients-do-not-return-to-work [Accessed 02.06.16])
        • National Heart Foundation of Australia
        Heart attack survivor surveys 2012-2015.
        National Heart Foundation of Australia, Melbourne2016
        • Australian Institute of Health and Welfare
        Health care expenditure on cardiovascular diseases 2008-09 (Cat. No. CVD 65).
        Australian Institute of Health and Welfare, Canberra2014
        • Department of Health
        Medicare statistics.
        Department of Health, Canberra2015
        • Liu J.
        • Maniadakis N.
        • Gray A.
        • Rayner M.
        The economic burden of coronary heart disease in the UK.
        Heart. 2002; 88: 597-603
        • Productivity Commission
        Evaluation of the pharmaceutical industry and investment program.
        Productivity Commission, Canberra2003
        • Mooney M.
        • McKee G.
        • Fealy G.
        • O’Brien F.
        • O’Donnell S.
        • Moser D.
        A review of interventions aimed at reducing pre-hospital delay time in acute coronary syndrome: what has worked and why?.
        Eur J Cardiovasc Nurs. 2012; 11: 445-453
        • Frieden T.
        Six components necessary for effective public health implementation.
        Am J Public Health. 2014; 104: 17-22
        • Smith B.
        • Ferguson C.
        • McKenzie J.
        • Bauman A.
        • Vita P.
        Impacts from repeated mass media campaigns to promote sun protection in Australia.
        Health Promot Int. 2002; 17: 51-60
        • Maddox T.
        • Reid K.
        • Mittleman M.
        • Krumholz H.
        • Parashar S.
        • Ho P.
        • et al.
        Angina at 1 year after myocardial infarction: prevalence and associated findings.
        Arch Intern Med. 2008; 168: 1310-1316
        • Scuffham P.
        • Tippett V.
        The cost-effectiveness of thrombyolysis administered by paramedics.
        Australian College of Ambulance Professionals Conference, Gold Coast, Queensland2007