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

Bradshaw, Pamela J.; Alfonso, Helman; Finn, Judith; Owen, Julie; Thompson, Peter L.

doi:10.1016/j.hlc.2009.11.001

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…8 Other studies in Australia have found disparities in revascularization rates for Aboriginal compared to non-Aboriginal patients of between 7% and 40%. 4,12,13,36 It is difficult to directly compare these findings with ours, because of differences in methods, study populations, and the level of adjustment in models. Overall, it appears that Aboriginal people receive fewer revascularization procedures than age-adjusted non-Aboriginal people, but once factors such as area of residence, hospital of admission, comorbidity burden, or private health insurance are taken into account, the disparity reduces.…”

Section: Discussionmentioning

confidence: 81%

“…36 Explanations for this might include the following: more extensive coronary artery disease and diabetes mellitus in Aboriginal patients, for which CABG may be the clinically preferred therapy 37 or clinician concern about rates of stent thrombosis (a rare but dangerous complication of PCI) for Aboriginal patients. Clinicians may be concerned about compliance with antiplatelet therapy, 38 particularly if the patient is returning to a rural or remote community where follow-up is less certain; however we could find no research on differential rates of antiplatelet therapy compliance or rates of stent thrombosis for Aboriginal and non-Aboriginal patients.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Revascularization Rates After Acute Myocardial Infarction Between Aboriginal and Non-Aboriginal People in Australia

et al. 2013

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Background— This study examined revascularization rates after acute myocardial infarction (AMI) for Aboriginal and non-Aboriginal patients sequentially controlling for admitting hospital and risk factors. Methods and Results— Hospital data from the state of New South Wales, Australia (July 2000 through December 2008) were linked to mortality data (July 2000 through December 2009). The study sample were all people aged 25 to 84 years admitted to public hospitals with a diagnosis of AMI (n=59 282). Single level and multilevel Cox regression was used to estimate rates of revascularization within 30 days of admission. A third (32.9%) of Aboriginal AMI patients had a revascularization within 30 days compared with 39.7% non-Aboriginal patients. Aboriginal patients had a revascularization rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission, and AMI type (adjusted hazard ratio, 0.63; 95% confidence interval, 0.57–0.70). Within the same hospital, however, Aboriginal patients had a revascularization rate 18% lower (adjusted hazard ratio, 0.82; 95% confidence interval, 0.74–0.91). Accounting for comorbidities, substance use and private health insurance further explained the disparity (adjusted hazard ratio, 0.96; 95% confidence interval, 0.87–1.07). Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness, and catheterization laboratory facilities. Conclusions— Aboriginal Australians were less likely to have revascularization procedures after AMI than non-Aboriginal Australians, and this was largely explained by lower revascularization rates at the hospital of first admission for all patients admitted to smaller regional and rural hospitals, a higher comorbidity burden for Aboriginal people, and to a lesser extent a lower rate of private health insurance among Aboriginal patients.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Disparities in Revascularization Rates After Acute Myocardial Infarction Between Aboriginal and Non-Aboriginal People in Australia

et al. 2013

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“…Ischaemic heart disease (IHD) accounts for 14% of the gap in burden of disease [2], and Aboriginal Australians have higher age-adjusted rates of incidence, hospital admission and mortality for acute myocardial infarction (AMI), the acute form of IHD [3,7-9]. While several studies have compared rates of invasive interventions [7,9-11], none has quantified the impact of hospital care on variations in short-term and long-term outcomes for Aboriginal and non-Aboriginal people after admission for AMI.…”

Section: Introductionmentioning

confidence: 99%

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

et al. 2012

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Background Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes. Methods Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality. Results Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status. Conclusions Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people.

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“…These apparently lower rates of coronary revascularisation in Aboriginal patients disappeared when patients were matched for age, sex and comorbidity. After this adjustment, the rates and type of intervention (including PCI and CABG surgery) during an ACS event were identical 98 . Similarly, the adjusted rates of evidence‐based prescribing for post‐hospital secondary prevention were similar in Aboriginal and non‐Aboriginal patients 99 …”

Section: Aboriginal and Torres Strait Islander Peoplementioning

confidence: 86%

Management of acute coronary syndrome in special subgroups: female, older, diabetic and Indigenous patients

McQuillan

Thompson

2014

Medical Journal of Australia

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Summary While the evidence base for management of acute coronary syndrome (ACS) is extensive, some subgroups have been underrepresented or excluded from relevant clinical trials. These subgroups — such as women, older people, diabetic patients and Indigenous Australians — present clinical challenges for which there is limited evidence to guide optimal therapy. Women may have a different pattern of presentation, with potential for delays in diagnosis and worse outcomes in ST‐elevation myocardial infarction, but there is no evidence that treatments affect them differently from men. Older people suffer from a high‐risk, low‐treatment paradox. This may be due to under‐appreciation of the benefits of treatments for older people, or to good clinical judgement in avoiding harm from worsening age‐related comorbidities. Patients with diabetes have a high risk of ACS and suffer worse outcomes. Moderate glycaemic control with close monitoring and avoidance of hypoglycaemia are recommended. Coronary artery bypass grafting is preferred to percutaneous coronary intervention for patients with diabetes and multivessel disease, although the latter is reasonable in single‐vessel disease. Indigenous patients have a high prevalence of coronary disease, with more frequent coronary events at a young age, a heavy load of risk factors and poor outcomes after ACS. The complex sociocultural barriers to treatment are yet to be addressed adequately.

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

Cited by 13 publications

References 9 publications

Disparities in Revascularization Rates After Acute Myocardial Infarction Between Aboriginal and Non-Aboriginal People in Australia

Disparities in Revascularization Rates After Acute Myocardial Infarction Between Aboriginal and Non-Aboriginal People in Australia

Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

Management of acute coronary syndrome in special subgroups: female, older, diabetic and Indigenous patients

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