The study published in the European Heart Journal Open (CORONARY study: Long-Term Clinical Outcomes and Cumulative Costs after Acute Coronary Syndrome: A Risk-Stratified Real-World Study with 5-Year follow-up in the Finnish population) is a retrospective study conducted in Siun Sote in collaboration between Novartis, wellbeing services county of North Karelia - Siun Sote, and ESiOR. The study examined the risk of recurrent cardiac events and the associated social and healthcare costs in patients who had experienced an acute cardiac event within the defined clinical risk categories during the five-year follow-up period after the initial event.1
The study included all patients aged 45-85 (n=3303) who had been admitted to the North Karelia Central Hospital for an acute coronary syndrome between 2017 and 2022 (n=1923) or underwent an elective procedure (percutaneous coronary intervention or coronary artery bypass grafting, n=1380). The risk of recurrent acute coronary events in the next five years for patients was assessed using the SMART-REACH risk calculator, which classified patients into five equally sized risk categories based on the risk assessment. SMART-REACH is an algorithm that calculates the risk of recurrent cardiovascular disease events based on baseline variables of the patient2. The study also examined the patients' utilization of social and healthcare services (emergency visits, outpatient and inpatient visits and admissions to primary and secondary healthcare, invasive procedures, and social services) and the associated costs during the five-year follow-up period according to risk categories.1
The CORONARY study demonstrated that LDL cholesterol levels were consistently high compared to treatment guideline recommendations. At baseline, only less than 10% of patients had reached their LDL cholesterol target, and this proportion increased to 16% at one year. There was also inadequate monitoring of LDL cholesterol levels. Almost all patients had their LDL cholesterol levels recorded at baseline, but at the three-month follow-up, LDL cholesterol data were missing for 27% of patients, and at one year, it was missing for 38% of patients.1
According to the SMART-REACH risk calculator suitable for secondary prevention patients, patients could be further divided into five different risk groups based on the assessment of the risk of recurrent cardiac events in the next five years. The risk of recurrent cardiac events varied significantly among the different risk groups. In the lowest-risk group according to the SMART-REACH calculator, the risk of recurrent cardiac events was 20%, while in the highest-risk group, it was 41%.1
The CORONARY study also examined the cumulative social and healthcare service costs over the five-year period, which amounted to approximately 94 million euros for all patients included in the study. The cumulative costs per patient for social and healthcare services were significantly associated with the magnitude of the risk of recurrent cardiac events. In the lowest-risk group, the cumulative costs were 15,511 euros per patient, while in the highest-risk group, they were 44,859 euros per patient.1
The CORONARY study demonstrated that the SMART-REACH risk calculator makes it possible to further categorize high-risk secondary prevention patients into subgroups with significantly different risks of recurrent cardiac events and cumulative costs1. This means that this type of risk stratification could be a practical tool to identify patients who have experienced an acute cardiac event and are at particularly high (or low) risk of recurrent events. Additionally, this classification would enable more targeted treatment planning and allocation of limited resources, potentially leading to long-term cost savings.