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Inpatient cardiac care for acute coronary syndromes in the Top End of Australia

Authors :
Marcus Ilton
Nathanial McMurdock
Edwina Wing-Lun
Nadarajah Kangaharan
Joanne Eng-Frost
James Marangou
Source :
Internal Medicine Journal. 53:383-388
Publication Year :
2022
Publisher :
Wiley, 2022.

Abstract

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.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.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).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).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.

Details

ISSN :
14455994 and 14440903
Volume :
53
Database :
OpenAIRE
Journal :
Internal Medicine Journal
Accession number :
edsair.doi.dedup.....a21fc90c78c019273db7b67e47fefe27
Full Text :
https://doi.org/10.1111/imj.15597