Cardiac procedures in ST-segment-elevation myocardial infarction - the influence of age, geography and Aboriginality

Abstract

Background: Timely restoration of bloodflow acute ST-segment elevation myocardial infarction (STEMI) reduces myocardial damage and improves prognosis. The objective of this study was describe the association of demographic factors with hospitalisation rates for STEMI and time to angiography, Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. Methods: This was an observational cohort study using linked population health data. We used linked records of NSW and the ACT hospitalisations and the Australian Government Medicare Benefits Schedule (MBS) for persons aged 35 and over hospitalised with STEMI in the period 1 July 2010 to 30 June 2014. Survival analysis was used to determine the time between STEMI admission and angiography, PCI and CABG, with a competing risk of death without cardiac procedure. Results: Of 13,117 STEMI hospitalisations, 71% were among males; 55% were 65-plus years; 64% lived in major cities, and 2.6% were Aboriginal people. STEMI hospitalisation occurred at a younger age in males than females. Angiography and PCI rates decreased with age: angiography 69% vs 42% and PCI 60% vs 34% on day 0 for ages 35-44 and 75-plus respectively. Lower angiography and PCI rates and higher CABG rates were observed outside major cities. Aboriginal people with STEMI were younger and more likely to live outside a major city. Angiography, PCI and CABG rates were similar for Aboriginal and non-Aboriginal people of the same age and remoteness area. Conclusions: There is a need to improve access to definitive revascularisation for STEMI among appropriately selected older patients and in regional areas. Aboriginal people with STEMI, as a population, are disproportionately affected by access to definitive revascularisation outside major cities. Improving access to timely definitive revascularisation in regional areas may assist in closing the gap in cardiovascular outcomes between Aboriginal and non-Aboriginal people.

Differences in outcome of percutaneous coronary intervention between Indigenous and non-Indigenous people in Victoria, Australia: a multicentre, prospective, observational, cohort study

“…3 These higher rates of cardiovascular disease and mortality are compounded by disparities in cardiovascular care. Although both life expectancy and disparities in care have seen substantial improvements over the past 15 years, 1,6 differences in access to specialist review, 6 angiography, 18,19 and revascularisation treat ments 6,7,20 remain between Indigenous Australians and non-Indigenous Australians. Our data suggest that these inequalities extend to shortterm and long-term outcomes following PCI in Victoria, with higher risk of MACE and mortality independent of comorbidities, clinical presentation, socioeconomic status, and geographical remoteness.…”

Investigating inequities in cardiovascular care and outcomes for Queensland Aboriginal and Torres Strait Islander people: protocol for a hospital-based retrospective cohort data linkage project

“…10 Analysis of linked administrative data from New South Wales (NSW) revealed 33% of Aboriginal and Torres Strait Islander peoples received revascularisation after hospitalisation for acute myocardial infarction (MI), significantly less than other people from NSW, 11 which may be explained by differences in remoteness and age profiles. 12 Similarly, Aboriginal and Torres Strait Islander people hospitalised for MI in NSW had excess 1-year mortality compared with other NSW patients with MI, although this appeared to be explained by a higher burden of comorbidity among the Aboriginal and Torres Strait Islander cohort. 13 In the Northern Territory, linked data have been used to demonstrate higher lifetime health costs of stroke for Aboriginal and Torres Strait Islander people compared with other Northern Territory residents.…”