Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals

Kotwal, Sradha; Ranasinghe, Isuru; Brieger, David; Clayton, Philip; Cass, Alan; Gallagher, Martin

doi:10.1016/j.hlc.2015.07.019

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…Geographical variation in care may be due to the lack of availability of cardiologists, catheterization laboratories, and medical treatments in rural areas compared with urban areas . For example, a study assessing outcomes in patients with acute MI in New South Wales, Australia, showed that patients with NSTEMI presenting to a rural hospital were 70% less likely to undergo cardiac revascularization than patients presenting to an urban hospital . Geographical variation in care may also be affected by the financial burden of different P2Y 12 inhibitors to patients worldwide.…”

Section: Challenges For the Treatment Of Patients With Nstemimentioning

confidence: 99%

“…60 For example, a study assessing outcomes in patients with acute MI in New South Wales, Australia, showed that patients with NSTEMI presenting to a rural hospital were 70% less likely to undergo cardiac revascularization than patients presenting to an urban hospital. 61 Geographical variation in care may also be affected by the financial burden of different P2Y 12 inhibitors to patients worldwide. Prasugrel and ticagrelor are generally more expensive than clopidogrel, which is no longer patented.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Ahrens

Zúñiga

et al. 2019

Clinical Cardiology

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Clinical guidelines for the treatment of patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long‐term mortality risk than patients with ST‐segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the “treatment‐risk paradox”). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four “P” factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long‐term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

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Section: Challenges For the Treatment Of Patients With Nstemimentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Ahrens

Zúñiga

et al. 2019

Clinical Cardiology

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“…Rural residents have a different experience of health services. Rurality has been associated with higher mortality and, in Australia, inferior access to preventive and acute health services . Rurality also impacts upon patterns of renal service use, as rural residents use a lower proportion of dialysis care compared with their urban counterparts …”

Section: Introductionmentioning

confidence: 99%

Effects of health service geographic accessibility in patients with treated end stage kidney disease: Cohort study 2000–2010

et al. 2017

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“…Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors [3,4]. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations.…”

Section: The Rural and Regional Contextmentioning

confidence: 99%

Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement

Arnold

Tideman²,

Devlin

et al. 2020

Heart, Lung and Circulation

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The Challenges Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations, and people with known CVD have increased morbidity and mortality from coronavirus disease 2019 (COVID-19). In addition, COVID-19 is associated with serious cardiac manifestations, potentially placing additional demand on limited regional services at a time of diminished visiting metropolitan support with restricted travel. Inter-hospital transfer is currently challenging as receiving centres enact pandemic protocols, creating potential delays, and cardiovascular resources are diverted to increasing intensive care unit (ICU) and emergency department (ED) capacity. Regional and rural centres have limited staff resources, placing cardiac services at risk in the event of staff infection or quarantine during the pandemic.

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Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals

Abstract: Presentation to a regional and remote hospital was associated with lower revascularisation rates following AMI, but with a higher long-term mortality if presenting with ST segment elevation.

Cited by 14 publications

References 30 publications

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Effects of health service geographic accessibility in patients with treated end stage kidney disease: Cohort study 2000–2010

Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement

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