Follow-up of Australian Aboriginal Patients Following Open-Heart Surgery in Western Australia

Percutaneous Balloon Mitral Commissurotomy in Indigenous versus Non-Indigenous Australians

“…A strategy which avoids cardiac surgery and in particular mitral valve replacement is desirable in this group of patients given the inherent concerns regarding compliance with anticoagulation regimens and surgical outcomes noted by some authors. [15][16][17] We review the clinical, haemodynamic and both immediate and longer term outcomes of 327 consecutive cases requiring PBMC at the Prince Charles Hospital and the Holy Spirit Northside Brisbane and compare outcomes between IA and NIA groups.…”

The Use of Coronary Revascularisation Procedures in Urban Australian Aboriginals and a Matched General Population

“…Aboriginal people admitted to hospital in Perth, WA, with IHD were more likely to undergo CABG than PCI, a finding made by others [3]. A review of 57 Aboriginal patients after CABG in a Perth teaching hospital [7] found they tended to suffer more diffuse coronary disease, which may explain the greater use of CABG rather than PCI. Diabetes, which is associated with an earlier onset of CHD and with more diffuse coronary disease was more than twice as prevalent among Aboriginals admitted with CHD than among the matched cohort.…”

“…This excess of diabetes and the preference for CABG over PCI for patients with diabetes and multi-vessel obstructive coronary artery disease, even since the introduction of drug-eluting stents [8], may explain the greater use of CABG among PAARS patients. Concerns about lack of access to [9], or lack of compliance with [7], cardiac rehabilitation may also sway cardiologists and surgeons to prefer CABG for Aboriginal patients, as the use of PCI with stents requires adherence to a sustained regimen of medications. The Aboriginal patients in the post-CABG study also had a higher incidence of co-morbidities [3,7]; which has been associated with a reduced probability of having a procedure [3].…”

“…Concerns about lack of access to [9], or lack of compliance with [7], cardiac rehabilitation may also sway cardiologists and surgeons to prefer CABG for Aboriginal patients, as the use of PCI with stents requires adherence to a sustained regimen of medications. The Aboriginal patients in the post-CABG study also had a higher incidence of co-morbidities [3,7]; which has been associated with a reduced probability of having a procedure [3]. Revascularisation procedures as a proportion of all IHD admissions and the likelihood of undergoing a revascularisation procedure during an admission for an ACS did not differ significantly between the Aboriginal and non-Aboriginal patients.…”

Medical Management of Chronic Rheumatic Heart Disease

“…Problems with medication adherence, especially long-term anticoagulation with Warfarin, mean that mechanical valve replacement is not always the appropriate option, even for adult patients. Long-term follow-up studies in Australia have shown a significantly poorer outcome for Indigenous patients who have undergone valve surgery than non-Indigenous patients [7][8][9]. This is partly due to problems with medication adherence, difficulties in following up patients who may come from rural or remote areas and inadequate health literacy.…”