Inpatient cardiac care for acute coronary syndromes in the Top End of Australia. Issue 3 (13th August 2022)

• Record Type: Journal Article
• Authors: Eng‐Frost, Joanne; Marangou, James; McMurdock, Nathanial; Kangaharan, Nadarajah; Ilton, Marcus; Wing‐Lun, Edwina
• Is Part Of: Internal medicine journal. Volume 53:Issue 3(2023)
• Page Start: 383
• Page End: 388
• Publication Date: 2022-08-13
• Subjects: indigenous health -- acute coronary syndrome -- cardiovascular disease -- coronary artery disease -- healthcare disparity -- myocardial infarction; Medicine -- Periodicals; 616
• DOI: 10.1111/imj.15597
• Languages: English
• ISSNs: 1444-0903

Abstract

Abstract: Background: Disparities in cardiovascular outcomes between Aboriginal and Torres Strait Islander Australians and non‐Indigenous Australians persist. This has previously been attributed to a combination of differences in burden of cardiovascular disease risk factors, and inpatient access to guideline‐recommended care. Aims: To assess differences in inpatient access to guideline‐recommended acute coronary syndrome (GR‐ACS) treatment between Aboriginal and Torres Strait Islander and non‐indigenous patients admitted to Royal Darwin Hospital (RDH) with index ACS event. Methods: This retrospective study included index ACS admissions ( n = 288) to RDH between January 2016 and June 2017. Outcomes included rates of coronary angiography, percutaneous coronary intervention (PCI), surgical revascularisation, GR‐ACS medications prescribed on discharge and short‐term outcomes (30‐day mortality and ACS readmissions; 12‐month all cardiac‐related readmissions). Results: Two hundred and eighty‐eight patients, including 109 (37.85%) Aboriginal and Torres Strait Islander patients, were included. Compared with non‐indigenous patients, they were younger (median age 48 years vs 60 years; P < 0.01), with a greater burden of comorbidities, including diabetes (39% vs 19%; P < 0.01), smoking (68% vs 35%; P < 0.01) and chronic kidney disease (29% vs 5%; P < 0.01). There were no differences in rates of coronary angiography (98% vs 96%; P = 0.24) or PCI (47% vs 57%; P = 0.12), although there was a trend towards surgical revascularisation in Aboriginal and Torres Strait Islander patients (16% vs 8%; P = 0.047). There were no differences in 30‐day mortality (1.8% vs 1.7%; P = 0.72), 12‐month ACS readmissions (7% vs 4%; P = 0.20) or 12‐month cardiac‐related readmissions (7% vs 13%; P = 0.11). Conclusions: Aboriginal and Torres Strait Islander patients received similar inpatient ACS care and secondary prevention medication at discharge, with similar short‐term mortality outcomes as non‐indigenous patients. While encouraging, these outcomes may not persist long term. Further outcomes research is required, with differences compelling consideration of other primary and secondary prevention contributors.