A comparison of clinical characteristics and outcomes between Indigenous and non-Indigenous patients presenting to Townsville Hospital Emergency Department with chest pain

Win, Kyi T.H., Thomas, Benjamin, Emeto, Theophilus I., Fairley, Lachlan, Thavarajah, Harshithaa, Vangaveti, Venkat N., Danda, Nita, Wai, Htet, New, Ru, Munoz, Miguel, Basu, Sonali, and Yadav, Raibhan (2021) A comparison of clinical characteristics and outcomes between Indigenous and non-Indigenous patients presenting to Townsville Hospital Emergency Department with chest pain. Heart, Lung and Circulation. (In Press)

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Abstract

Background: Indigenous Australians have a high rate of ischaemic heart disease (IHD). There is a paucity of local data for North Queensland regarding the clinical characteristics of Indigenous people who present to the emergency department (ED) with chest pain. The aim of the study is to compare the cardiovascular risk factors, social characteristics, and the clinical outcomes between Indigenous and non-Indigenous patients who presented with cardiac-related chest pain.

Methods: This is a retrospective single-centre audit. The data was collected through chart reviews of chest pain presentations to the Townsville University Hospital Emergency Department from January to December 2017. We categorised the patients into Indigenous and non-Indigenous groups and compared their cardiac risk factors and social characteristics. We further classified the patients into three diagnosis groups and we measured the clinical outcomes in the patients with a diagnosis of cardiac-related chest pain. We used a data linkage to the Registry of Births, Deaths and Marriages for the death outcomes. A multivariable analysis was done to determine the risk of major adverse cardiac event (MACE) for Indigenous vs non-Indigenous patients.

Results: Indigenous patients were over-represented making up 19.1% of the total cohort (compared with 11.1% of the North Queensland Indigenous population) and presented at a younger age (median age: 45 vs 52, p<0.005). Traditional cardiovascular risk factors were significantly higher in Indigenous patients. The incidence of discharge against medical advice was also higher (6.5% vs 2.7%, p<0.005). There was an underutilisation of the local chest pain pathway amongst the Indigenous group (35.8% vs 44.7%, p<0.005). In patients with a diagnosis of cardiac-related chest pain, the rate of receiving invasive coronary angiogram procedures was similar in both cohorts (44.5% vs 43.7%, p=0.836).

With regards to outcomes, Indigenous patients suffered from acute coronary syndrome (ACS) at a younger median age (51 vs 64, p<0.005) and were more likely to have severe three vessel disease (17% vs 6%, p<0.005) leading to coronary bypass graft surgery (CABG) (19% vs 6%, p<0.005). When adjusted for age, gender, and comorbidities, Indigenous patients were more likely to have MACE within 1 year of their chest pain presentation, compared with non-Indigenous patients with the same diagnosis (adjusted odds ration [AOR]=2.0, 95% CI [1.1, 3.8], p=0.03).

Conclusion: In our study, Indigenous patients carried a heavier burden of cardiovascular risk factors, presented at a younger age, with more severe coronary disease and had a higher rate of CABG. We found an underutilisation of the local chest pain protocol amongst the Indigenous cohort, which suggests a need to improve support structures in the ED. In our multivariable analysis, Indigenous patients suffered from a significantly higher MACE compared to non-Indigenous patients which indicates that more collaborative efforts are needed to improve the cardiovascular health of local Aboriginal and Torres Strait Islander people.

Item ID: 69259
Item Type: Article (Research - C1)
ISSN: 1444-2892
Keywords: Indigenous, Chest pain, Ischaemic heart disease, Closing the gap, Cardiovascular risk factors
Copyright Information: © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).Published by Elsevier B.V. All rights reserved.
Funders: Townsville Hospital and Health Service
Date Deposited: 14 Sep 2021 02:52
FoR Codes: 49 MATHEMATICAL SCIENCES > 4905 Statistics > 490502 Biostatistics @ 30%
42 HEALTH SCIENCES > 4202 Epidemiology > 420205 Epidemiological modelling @ 30%
42 HEALTH SCIENCES > 4206 Public health > 420602 Health equity @ 40%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 40%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 30%
20 HEALTH > 2004 Public health (excl. specific population health) > 200407 Health status (incl. wellbeing) @ 30%
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