OBJECTIVES

: ACEF score, calculated based on three independent variables, is a significant predictor of major adverse cardiac events for patients who underwent acute myocardial infarction. The long-term implications of decreasing ACEF score is unknown. In the absence of long-term clinical trials, modelling is a useful tool that helps to determine the optimal treatment strategy and predict a long-term impact of treatment. This study aims to predict the life years gained (LYG) in patients with decreased ACEF score over their lifetime by using the Markov modelling.

METHODS

: Our target cohort consisted of patients with new MI and age of 60. Hypothetical intervention was decreasing ACEF. A markov model was developed based on the previous study assessing cost-effectiveness in patients treated with standard of therapy at risk of vascular event in the UK. The model included six mutually exclusive Markov state: two of vascular event (MI/stroke), two of stable condition (Post MI/stroke) and two of death distinguished by cause (Vascular/Non-vascular). The transition probabilities for each disease state and death were retrieved from previous study, which the vascular rate utilized came from UK observational studies, and 2013 life table of Korean. The trial-based hazard ratio was used as effectiveness parameter to differentiate vascular event rate across levels of ACEF score. The hazard ratio for each x-point decrease of ACEF score was obtained with the following formula:

RESULTS

: The incremental QALYs and LGY by decreasing 0.1 point of ACEF scores resulted in 0.21 and 0.27, respectively. As the point decrease of ACEF scores became greater, incremental QALYs and LYG would increase significantly.

CONCLUSIONS

: The strategy of decreasing the ACEF score results in increasing LMG and QALMs. The improvement of ejection fraction would be helpful to improve patients QoL through reducing the 2^nd vascular events.