Enigma – Proud to have delivered ‘Biggest NZ nationwide study’.

Yesterday, the NZ National Heart Foundation published a web article titled ‘Biggest NZ nationwide study has global impact’.

It outlined the findings of a two-year-long, national, randomised trial to examine the effect of providing ambulatory oxygen to patients suspected of suffering a heart attack. This has long been a practice observed due to its suspected benefit, however this benefit has never been confirmed.

This study is the largest randomised trial to date in NZ, involving 40,000 patients, and it was made possible by leveraging off of the ANZACS-QI system, a national cardiology registry provided by Enigma to the NZ Ministry of Health, and deployed into each NZ hospital, nationwide.

The core ANZACS-QI registry system has been extended, using funding from the ANZACS-QI Registry Trials Group to include a ‘studies module’ which provides bolt-on templates for a range of associated studies.

The studies module allows patients from the core ANZACS-QI cohort to be included in appropriate research cohorts, and for additional, study-specific information to be collected on them, perhaps including study-specific workflows and additional subsequent (post-discharge) data capture. It also provides the potential for external healthcare providers to contribute additional information on patients after they have left the hospital setting.

For this study, data relating to Oxygen-as-a-therapy was retrospectively collected on all patients who were entered into the ANZACS-QI Acute Coronary Syndrome (ACS) data collections, on a single randomised day each month. Oxygen fields were present on all days, for all patients, but were made mandatory for patients who entered the hospital system on those specific, randomly selected days. In this way, the normal clinical practice of providers was not affected nor influenced in any way, by the presence of the study.

For more details on the study’s findings visit: https://www.heartfoundation.org.nz/about-us/news/media-releases/biggest-nz-nationwide-study-has-global-impact

Enigma is proud to have played a part in this and wishes to acknowledge and thank the NHF for their support of this study.

The value of ANZACS-QI for NZ


ANZACS-QI is a National system delivered within NZ to all of the public and private Coronary Care units and Cathlabs. It forms a National Registry to collect data on all patients who present with suspected Acute Coronary Syndrome, as well as those who are treated within Cathlabs, and who receive device implants as part of their cardiac-care treatment. The system is based on the PREDICT platform and was developed by Enigma in conjunction with Dr Andrew Kerr with funding from CMDHB. It was further developed later, with the NZ Cardiac Network, under contract with New Zealand’s Ministry of Health and has been delivered nationally in partnership with NIHI.

The following excerpts are taken from an editorial article [Mark Webster; ‘Early angiography and revascularisation for acute coronary syndromes in New Zealand’, NZMJ – 8th Jan, 2016] – Full article is available here with subscription: https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1428-8-january-2016/6678

Excerpts taken from the referenced editorial article:


ANZACS-QI is a rigorous, prospective and comprehensive database on all patients with ACS undergoing angiography. … The 3-day target time for angiography in ACS patients was an excellent choice as a KPI: clinically relevant, achievable and with the potential to save money. This has proven to be the case.


ANZACS-QI is now providing a wealth of information about the management of coronary disease in New Zealand. Merging data from other sources, particularly the national mortality, hospital discharge diagnosis codes and pharmacy registries, creates a powerful tool for predicting longer-term outcomes. …



The potential for ANZACS-QI extends well beyond short-term audit and quality control of local practice. Research can be under-taken by adding database fields for the duration of a study, and national registries used to collect relevant endpoints. … New Zealand is now well placed for such research; being small and somewhat isolated is, for once, to our advantage. Beyond the usual randomised trials with individual patient consent, there is also the potential to undertake systems research, comparing ‘routine’ practices applied to large groups of patients.


In summary, ANZACS-QI is an example of money well spent in a public health service looking to achieve both optimal clinical outcomes and efficient health service delivery. Without good data, it is easy to repeat the mistakes of the past. As Lord Kelvin said “to measure is to know”. It is vital that we evaluate our practice in an ongoing and rigorous manner … ; it is also important to maintain a healthy scepticism regarding our currently-held beliefs.

Further information on the ANZACS-QI system is available here: http://www.enigma.co.nz/predict-medical/anzacs-qi/

Further information on the extensions of this base system to service research / study requirements is available here: http://www.enigma.co.nz/predict-medical/anzacs-qi-registry-trials/

About Mark Webster: Mark works as a Consultant Cardiologist, Director, Cardiac Catheterisation Laboratories Auckland City Hospital and is Hon. Associate Professor of Medicine, University of Auckland.