A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia

Abstract

Aboriginal and Torres Strait Islander patients with acute coronary syndromes (ACS) experience lower intervention rates and poorer outcomes compared with non-Indigenous patients. A broad range of geographical, cultural and systemic factors contribute to delays and suboptimal treatment for ACS. Every Indigenous ACS patient, regardless of where they live, should be able to expect a coordinated, patient-centred pathway of care provided by designated provider clinical networks and supported by Indigenous cardiac coordinators, Aboriginal liaison officers (ALOs) and health workers. These designated provider clinical networks provide: appropriate prehospital and inhospital treatment an individualised patient care plan developed jointly with the patient and his or her family culturally appropriate education initiated within the hospital setting and involving families with support from ALOs effective follow-up care and access to relevant secondary prevention programs. We outline generic pathways to provide policymakers, health planners and health care providers with a framework for ACS diagnosis and management that can be implemented across the diverse settings in which Aboriginal and Torres Strait Islander people reside and their care is delivered, in order to optimise care and assertively address the current disparities in outcomes.

Disparities in acute in‐hospital cardiovascular care for Aboriginal and non‐Aboriginal South Australians

“…To further examine the causes of the disparity in angiography rates, we undertook a medical record review of all Aboriginal ACS admissions in the hospital data, matched with data for a non‐Aboriginal cohort. This information provided insight into the medical decision‐making processes for Aboriginal ACS patients and confirmed that a negative hospital experience, bias based on complex comorbidities or presumed adherence to medications that favoured conservative management, and patient choice were implicated in the difference in angiography rates 6 , 14 , 15 …”

Cardiac care for Indigenous Australians: practical considerations from a clinical perspective

“…However, disparities in ACS care for Indigenous people are well documented 12 . Here, we present a practical application of the guidelines for use in the Indigenous setting 13 …”

“…Enrolment in cardiac rehabilitation programs is beneficial after ACS, 13 but participation rates of Indigenous people are low. Reasons for this include distance, extended family responsibilities, socio‐cultural inappropriateness of programs, poor understanding of cardiac rehabilitation and the younger age of the Indigenous population with ACS (as patients in their 20s or 30s are less compliant and less likely to accept clinical recommendations).…”

Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

“…There is a lack of sustained lockstep measures addressing one issue from multiple angles (Box 4 ). Exceptions include work from Brown et al , which provide strong foundations, with elements that are implementable [47], to continue a program of work [50-54]. …”