Acute myocardial infarction incidence and survival in Aboriginal and non-Aboriginal populations: an observational study in the Northern Territory of Australia, 1992–2014

Coffey, Cushla; Zhao, Yuejen; Condon, John R.; Li, Shu; Guthridge, Steven

doi:10.1136/bmjopen-2020-036979

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…Indigenous status is collected via self-report on admission in all Australian hospitals. Data on indigenous status were included in this study because coronary events have been found to occur at an earlier age in Indigenous populations in Australia . Also excluded were patients who were treated palliatively who would not have been offered reperfusion, those with cardiac arrest with no return of spontaneous circulation, or those with traumatic injuries with a clear noncardiac cause.…”

Section: Methodsmentioning

confidence: 99%

“…Data on indigenous status were included in this study because coronary events have been found to occur at an earlier age in Indigenous populations in Australia. 9 , 10 Also excluded were patients who were treated palliatively who would not have been offered reperfusion, those with cardiac arrest with no return of spontaneous circulation, or those with traumatic injuries with a clear noncardiac cause. Clinicians within rural hospitals randomized to the MORACS intervention were educated regarding the intervention to enable implementation and engagement; clinicians in the usual care hospitals were not.…”

Section: Methodsmentioning

confidence: 99%

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Management of Acute Coronary Syndromes in Patients in Rural Australia

et al. 2022

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Treatment of ST-segment elevation myocardial infarction (STEMI) in rural settings involves thrombolysis followed by transfer to a percutaneous coronary intervention-capable hospital. The first step is accurate diagnosis via electrocardiography (ECG), but one-third of all STEMI incidents go unrecognized and hence untreated. OBJECTIVE To reduce missed diagnoses of STEMI. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial included 29 hospital emergency departments (EDs) in rural Australia with no emergency medicine specialists, which were randomized to usual care vs automatically triggered diagnostic support from the tertiary referral hospital (management of rural acute coronary syndromes [MORACS] intervention). Patients presenting with symptoms compatible with acute coronary syndromes (ACS) were eligible for inclusion. The study was conducted from December 2018 to April 2020. Data were analyzed in August 2021.INTERVENTION Triage of a patient with symptoms compatible with ACS triggered an automated notification to the tertiary hospital coronary care unit. The ECG and point-of-care troponin results were reviewed remotely and a phone call was made to the treating physician in the rural hospital to assist with diagnosis and initiation of treatment. MAIN OUTCOMES AND MEASURESThe proportion of patients with missed STEMI diagnoses.RESULTS A total of 6249 patients were included in the study (mean [SD] age, 63.6 [12.2] years; 48% female). Of 7474 ED presentations with suspected ACS, STEMI accounted for 77 (2.0%) in usual care hospitals and 46 (1.3%) in MORACS hospitals. Missed diagnosis of STEMI occurred in 27 of 77 presentations (35%) in usual care hospitals and 0 of 46 (0%) in MORACS hospitals (P < .001). Of eligible patients, 48 of 75 (64%) in the usual care group and 36 of 36 (100%) in the MORACS group received primary reperfusion (P < .001). In the usual care group, 12-month mortality was 10.3% (n = 8) vs 6.5% (n = 3) in the MORACS group (relative risk, 0.64; 95% CI, 0.18-2.23). Patients with missed STEMI diagnoses had a mortality of 25.9% (n = 7) compared with 2.0% (n = 1) for those with accurately diagnosed STEMI (relative risk, 13.2; 95% CI, 1.71-102.00; P = .001). Overall, there were 6 patients who did not have STEMI as a final diagnosis; 5 had takotsubo cardiomyopathy and 1 had pericarditis. There was no difference between groups in the rate of alternative final diagnosis. CONCLUSION AND RELEVANCEThe findings indicate that MORACS diagnostic support service reduced the proportion of missed STEMI and improved the rates of primary reperfusion therapy. Accurate diagnosis of STEMI was associated with lower mortality.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Management of Acute Coronary Syndromes in Patients in Rural Australia

et al. 2022

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Spontaneous coronary artery dissection: a clinically oriented narrative review

Dang,

Burgess,

Psaltis

et al. 2024

npj Cardiovasc Health

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Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. It is also associated with pregnancy, delivery, and the post-partum period. Despite an exponential rise in the volume of SCAD-focused research and publications within the past decade, SCAD is still a poorly understood condition, with a paucity of randomised controlled trial data. This review discusses the pathophysiology, clinical presentation, diagnosis and management of SCAD alongside areas for future research.

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Acute myocardial infarction incidence and survival in Aboriginal and non-Aboriginal populations: an observational study in the Northern Territory of Australia, 1992–2014

Cited by 2 publications

References 15 publications

Management of Acute Coronary Syndromes in Patients in Rural Australia

Management of Acute Coronary Syndromes in Patients in Rural Australia

Spontaneous coronary artery dissection: a clinically oriented narrative review

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