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

Abstract

Indigenous Australians have a much high burden of cardiovascular disease, which occurs at an earlier age than in the non-Indigenous population. Comorbidities such as diabetes are common. Early diagnosis of ischaemic heart disease may be difficult because of barriers such as distance to medical centres, communication problems and family and cultural responsibilities. Disparities in cardiac care between Indigenous and non-Indigenous populations are well documented, with examples including reduced angiography and revascularisation rates in Indigenous patients. Indigenous patients can have poor health literacy and need careful explanation of procedures, with the assistance of Aboriginal health workers, visual aids and family members. Acute rheumatic fever and chronic rheumatic heart disease remain ongoing health problems in Indigenous communities, especially in remote areas. Ambulatory care of Indigenous Australians with chronic cardiovascular disease is challenging. It requires well supported health care systems, including Aboriginal health workers and cardiac nurse coordinators to case-manage patients. A holistic approach to care, with attention directed towards both cardiac and non-cardiac comorbidities, is crucial for optimal management of cardiovascular disease in Indigenous Australians. Multidisciplinary care, involving an empowered and supported primary care team working together with specialists through outreach services or telehealth, is important for patients who are at high clinical risk and those living in remote areas. Indigenous Australians deserve the same level of evidence-based cardiovascular health care and access to care as non-Indigenous Australians.

Differences in outcome of percutaneous coronary intervention between Indigenous and non-Indigenous people in Victoria, Australia: a multicentre, prospective, observational, cohort study

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Can the CHA2DS2‐VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non‐valvular atrial fibrillation?

“…Although there are limited data on the use of NOAC in this population, the lack of International Normalized Ratio monitoring and the significantly reduced risk of intracranial bleeding with NOAC make them an attractive treatment option to warfarin 3 . A greater appreciation of the high risk of stroke in young Aboriginal Australians with non‐rheumatic AF, along with enhanced screening and integrated care with culturally sensitive pathways to treatment, should lead to improved rates of OAC therapy for stroke prevention in this medically underserved population 6,19,20 …”

Māori, Pacific, Aboriginal and Torres Strait Islander Women’s Cardiovascular Health: Where Are the Opportunities to Make a Real Difference?

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