Disparities in acute in‐hospital cardiovascular care for Aboriginal and non‐Aboriginal South Australians

Abstract

Objectives: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non‐Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences. Design: Analysis of administrative data with logistic regression modelling to assess the relationship between Aboriginal status and the decision to undertake diagnostic angiography. A detailed medical record review of Aboriginal admissions was subsequently undertaken. Setting: Emergency ACS admissions to SA cardiac catheterisation hospitals, 2007–2012. Participants: 13 701 admissions of patients with an ACS, including 274 Aboriginal patients (2.1%). Major outcome measures: Rates of coronary angiography and revascularisation; documentation of justification for non‐invasive management. Results: After adjustment for age, comorbidities and remoteness, Aboriginal patients presenting with an ACS were significantly less likely than non‐Aboriginal patients to undergo angiography (odds ratio [OR], 0.4; 95% CI, 0.3–0.5; P < 0.001). There was no significant difference in the rates of revascularisation for Aboriginal and non‐Aboriginal patients who had undergone angiography. Reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non‐cardiac (16%), non‐invasive test performed (8%), and discharge against medical advice (11%); the reasons were unclear for 36% of Aboriginal patients. Conclusions: After controlling for age and other factors, the rate of coronary angiography was lower among Aboriginal patients with an ACS in SA. The reasons for this disparity are complex, including patient‐related factors and their preferences, as well as the appropriateness of the intervention. Improved consideration of the hospital experience of Aboriginal patients must be a priority for reducing health care disparities.

Cardiac care for Indigenous Australians: practical considerations from a clinical perspective

“…11 However, disparities in ACS care for Indigenous people are well documented. 12 Here, we present a practical application of the guidelines for use in the Indigenous setting. 13 Indigenous patients who present to a health care facility with a suspected ACS must have access to a digital 12-lead ECG, which can, if necessary, be transmitted to a referral centre for assistance with decision making.…”

Embedding cultural safety in Australia's main health care standards

“…Integrating cultural safety in an active manner reconfigures health care to allow greater equity of realised access, rather than the assumption of full access, including procession to appropriate intervention. As an example of the need to improve equity, a South Australian study found that Indigenous people presenting to emergency departments with acute coronary syndrome were half as likely as non‐Indigenous patients to undergo angiography 7 . More broadly, Indigenous people admitted to hospital are less likely to have a procedure for a condition than non‐Indigenous people 8…”

“…As an example of the need to improve equity, a South Australian study found that Indigenous people presenting to emergency departments with acute coronary syndrome were half as likely as non-Indigenous patients to undergo angiography. 7 More broadly, Indigenous people admitted to hospital are less likely to have a procedure for a condition than non-Indigenous people. 8 Cardiovascular disease is the leading cause of death in Indigenous Australians.…”

The importance of Indigenous Health Liaison Officers and family meetings to improve cardiovascular outcomes in Indigenous Australians

“…Cardiovascular disease is the leading cause of death among Indigenous and non‐Indigenous Australians. Coronary artery disease (CAD) mortality is estimated to be twice as high in Indigenous than non‐Indigenous Australians, and Indigenous Australians are affected at an age that is, on average, 10–15 years younger than non‐Indigenous Australians 1 . Rheumatic heart disease, now rare in the Western world, continues to affect Indigenous Australians at disproportionate levels.…”

“…The disparities in both coronary artery and valvular disease contribute significantly to the gap in life expectancy between Indigenous and non‐Indigenous Australians. Despite this, studies have shown that rates of diagnostic coronary angiography, percutaneous coronary intervention and coronary artery bypass grafting are all lower for Aboriginal Australians, when compared with their matched non‐Indigenous counterparts 1 . A number of factors contribute to the marked disparities in incidence and treatment of cardiovascular disease among Indigenous and non‐Indigenous Australians.…”