The management of Indigenous patients presenting with non ST-segment elevation acute coronary syndrome in South Australia: a retrospective cohort study

Roe, Y.L., Esterman, A., McDermott, R., and Zeitz, C. (2016) The management of Indigenous patients presenting with non ST-segment elevation acute coronary syndrome in South Australia: a retrospective cohort study. Internal Medicine Journal, 46 (2). pp. 202-2013.

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Abstract

Aim: Using Australian guidelines for management of acute coronary syndromes (ACS), we assessed the probability of an Indigenous patient receiving interventional and therapeutic care after presenting in two metropolitan hospitals.

Methods: A retrospective case note review of patients admitted through two Adelaide public tertiary hospital emergency departments from December 2007 to December 2009. The study cohort was 488 patients with high-risk clinical features without ST-segment-elevation.

Results: Indigenous patients were significantly younger, present later in the disease process and have a higher burden of cardiovascular risk factors, when compared to non-Indigenous patients. Indigenous patients were 54% more likely to receive angiography (RR = 1.54; 95% CI 1.31;1.81) than non-Indigenous patients however this difference disappeared after adjustment for age, sex and propensity score. Indigenous patients were 20% more likely to receive the recommended medications (RR = 1.19, 95% CI 1.01;1.40) compared to non-Indigenous patients. Patients over 65 years were 53% less likely to receive an angiogram (RR = 0.47, 95% CI 0.38;0.56) and were 35% less likely to receive the recommended medications (RR = 0.65, 95% CI 0.54;0.78) than a patient at the ages of 18-49. Women were almost 20% less likely to receive an angiogram (RR = 0.81, 95% CI 0.66;0.99) and 20% less likely to receive the recommended medications (RR = 0.80, 95% CI 0.71;0.91) when compared to men. The likelihood of receiving medications on discharge was significantly influenced by age, gender, ethnicity, comorbid burden and revascularisation.

Conclusions: The younger age and significantly higher risk profile of Indigenous adults presenting to SA hospitals with ACS appears to lead to different management decisions, which may well be led by patient factors. Many of these risk conditions can be better managed in the primary care setting.

Item ID: 42359
Item Type: Article (Refereed Research - C1)
Keywords: Indigenous; acute coronary syndrome; age; diagnostic coronary angiography; gender; therapeutic intervention
ISSN: 1445-5994
Date Deposited: 10 Nov 2016 00:23
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 33%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920302 Aboriginal and Torres Strait Islander Health - Health Status and Outcomes @ 50%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920408 Health Status (e.g. Indicators of Well-Being) @ 50%
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