Cardiac disease is an unremitting catastrophe for Aboriginal Australians, both in terms of excess morbidity and premature mortality.1 The enormous burden of ischaemic heart disease is actually increasing and rates of rheumatic heart disease remain among the highest reported anywhere.2 This is in stark contrast to trends in non-Aboriginal Australians and minority Indigenous peoples of Canada, the US and New Zealand where morbidity and mortality differentials between Indigenous and non-Indigenous populations are converging.3,4 Aboriginal Australians have poor outcomes at every point along the way, ranging from failure of basic preventative measures and primary care at the community level through to cardiac surgery and post-surgery rehabilitation.