Eng-Frost, Joanne

Marangou, James

McMurdock, Nathanial

Kangaharan, Nadarajah

Ilton, Marcus

Wing-Lun, Edwina

2021-10-25

OBJECTIVE(S): To assess differences in inpatient access to guideline-recommended acute coronary syndrome (GR-ACS) treatment for Aboriginal and Torres Strait Islander and non-indigenous patients admitted to Royal Darwin Hospital (RDH) with index ACS event. DESIGN, SETTING AND PARTICIPANTS: Retrospective audit of index ACS admissions to RDH between January 2016 - June 2017. MAIN OUTCOME MEASURES: Rates of coronary angiography, percutaneous coronary intervention (PCI), surgical revascularisation, GR- ACS medications prescribed on discharge and short-term outcomes (30-day mortality and ACS readmissions; 12-month all cardiac-related readmissions) RESULTS: 288 patients, including 109 (37.85%) Aboriginal and Torres Strait Islander patients, were included. Compared to non-indigenous patients, they were younger (median age 48 years vs 60 years; p<0.01), with a greater burden of comorbidities including diabetes (38.53% vs 18.99%; p<0.01), smoking (67.89% vs 34.64%; p<0.01) and chronic kidney disease (29.36% vs 5.03%; p<0.01). There were no differences in rates of coronary angiography (98.17% vs 95.53%; p=0.24) or PCI (47% vs 57%; p=0.12), although there was a trend towards surgical revascularisation in Aboriginal and Torres Strait Islander patients (16% vs 8%; p=0.047). There were no differences in 30-day mortality (1.83% vs 1.68%; p=0.72), 12-month ACS readmissions (7.34% vs 3.91%; p=0.20) or 12-month cardiac-related readmissions (7.34% vs 13.41%; p=0.11). CONCLUSIONS: Aboriginal and Torres Strait Islander patients received similar inpatient ACS care and secondary prevention medication at discharge, with similar short-term mortality outcomes as non-indigenous patients. Differences in long-term cardiovascular outcomes and baseline cardiovascular risk factors compel consideration of other primary and secondary prevention contributors. This article is protected by copyright. All rights reserved.

Department of Cardiology, Flinders Medical Centre, Adelaide, SA.

Department of Cardiology, Royal Darwin Hospital, Darwin, NT.

Department of Cardiology, Fiona Stanley Hospital, Perth, WA.

Menzies School of Health Research, Darwin, NT.

Faculty of Medicine and Health, University of Sydney, Sydney, NSW.

Intern Med J . 2023 Mar;53(3):383-388. doi: 10.1111/imj.15597. Epub 2022 Aug 13.

0000-0002-7526-2078

https://pubmed.ncbi.nlm.nih.gov/34697864/?otool=iaurydwlib

https://hdl.handle.net/10137/11931

Inpatient Cardiac Care for Acute Coronary Syndromes in the Top End of Australia.

Journal Article

Publication