Three research projects have been awarded a total of just over $1 million to gather evidence in regards to the cost effectiveness and prioritisation of technologies in the area of ischaemic heart disease.
These projects have been funded through the Health Innovation Partnership, a joint initiative between the National Health Committee (NHC) and the Health Research Council of New Zealand (HRC). This partnership seeks to gather evidence to help the health and disability sector further improve the health and quality of life of New Zealanders while supporting cost effectiveness within the health sector.
The funded research projects are due to be completed in the first half of 2016 and will deliver evidence to inform the NHC’s recommendations to the Minister of Health regarding the cost effectiveness and prioritisation of new and existing technologies for ischaemic heart disease. This research will ensure that the NHC’s recommendations are based on high quality, up-to-date evidence that is drawn directly from New Zealand experience.
Elderly patients with cardiovascular disease are increasingly referred for complex, high cost interventions including cardiac surgery. Many elderly patients have good outcomes, but others have complications and poor outcomes irrespective of the treatment received, because of frailty, cognitive impairment or poor general health. For these patients major interventions such as coronary artery bypass may be less appropriate. However, these aspects of 'general health' are usually not systematically assessed. Dr Ralph Stewart at Auckland DHB will lead a project that will evaluate simple measures of frailty, co-morbidity, cognitive function, and general health in elderly patients with ischaemic heart disease admitted to hospitals throughout New Zealand. The study will assess how this information may modify clinical care, including potentially avoiding major interventions, morbidity and reduced quality of life for those unlikely to benefit.
In patients admitted to hospital with a heart attack, stenting is often performed to open the artery which caused the problem. Many patients also have narrowing in other arteries. In these cases it may not be clear whether stenting is beneficial. Professor Harvey White at Auckland DHB will lead a study that will evaluate whether measuring restricted flow down the artery will help facilitate this decision. This may lead to improved patient outcomes by reducing the need for repeat stenting and reducing the risk to these patients of having another heart attack.
Dr Martin Than at Canterbury DHB will lead a study that will pilot implementation of a new accelerated diagnostic pathway/protocol for suspected acute coronary syndromes cross New Zealand district health boards. Of the thousands of patients who present to New Zealand emergency departments every year with suspected cardiac chest pain, approximately 20 per cent could be discharged early. Large volumes of patients who do not have cardiac chest pain will be sent home early, reducing patient worry, increasing clinician availability to acutely ill patients, reducing emergency department overcrowding, reducing unnecessary inpatient admissions, and thereby reducing unnecessary health care costs.
The following list of successful applicants includes the named principal investigator only.
Dr Ralph Stewart
Auckland District Health Board
Evaluation of frailty and co-morbidity in patients with ischaemic heart disease
18 months, $345,756
Professor Harvey White
Auckland District Health Board
Cost effectiveness of fractional flow reserve in myocardial infarction
18 months, $350,000
Dr Martin Than
Canterbury District Health Board
Improving care processes for patients with possible acute coronary syndrome
18 months, $349,966