Evidence‐based prescribing of drugs for secondary prevention of acute coronary syndrome in <scp>A</scp>boriginal and non‐<scp>A</scp>boriginal patients admitted to <scp>W</scp>estern <scp>A</scp>ustralian hospitals

Gausia, Kaniz; Katzenellenbogen, Judith M.; Sanfilippo, Frank M; Knuiman, Matthew; Thompson, Peter L.; Hobbs, Michael; Thompson, Sandra

doi:10.1111/imj.12375

Cited by 16 publications

(28 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The significantly reduced participation in tertiary prevention following stroke in the indigenous population is likely to have a wide‐ranging impact on the health system and the individual . Length of stay following stroke is decreasing due to improvements in acute management .…”

Section: Discussionmentioning

confidence: 99%

Management of stroke in the Australian Indigenous population: from hospitals to communities

Tiedeman

Suthers

Julien

et al. 2019

Internal Medicine Journal

View full text Add to dashboard Cite

Background Ischaemic strokes lead to significant morbidity and mortality within the Australian Indigenous population, with known variances in the management of strokes between indigenous and non‐indigenous populations. Aims To compare investigations and management of indigenous and non‐indigenous patients presenting to a New South Wales rural referral hospital with an ischaemic stroke to the national stroke standards across inpatient and outpatient settings. Methods Historical cohort study of 43 indigenous and 167 non‐indigenous patients admitted to Tamworth Rural Referral Hospital with an ischaemic cerebrovascular accident. Results Indigenous patients were significantly less likely to have investigations completed, including carotid imaging (93.8% vs 100%, P = 0.012) and echocardiography (73.3% vs 97.7%, P = 0.004). Discharge follow up was significantly lower for the indigenous population (74.4% vs 87.4%, P = 0.034). Indigenous stroke patients were 15.8 years younger than non‐indigenous subjects (56.8 vs 72.6 years old; P < 0.001). Indigenous patients were more likely to have stroke risk factors, including smoking (51.2% vs 15.0%; P < 0.001), diabetes mellitus (37.2% vs 16.8%, P = 0.003) and past history of cerebrovascular accident or transient ischaemic attack (50.2% vs 31.1%, P = 0.032). Conclusions The investigation and post‐discharge care of indigenous ischaemic stroke patients is inferior to non‐indigenous patients. Indigenous patients within rural NSW have a higher prevalence of preventable disease, including those that confer a higher stroke risk. Further research is needed to investigate the cause of these discrepancies and to improving indigenous stroke care between hospitals and primary care providers.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of stroke in the Australian Indigenous population: from hospitals to communities

Tiedeman

Suthers

Julien

et al. 2019

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…Other studies have identified lower rates of evidence-based prescribing during hospitalization in more remote areas 14 and have identified physician specialty and hospital geographic region as independent predictors of evidence-based medical therapy prescription at discharge. 15 In our study, hospital and physician characteristics were important predictors of antiplatelet agent and statin use at discharge.…”

Section: Discussionmentioning

confidence: 99%

Prescription of Guideline-Based Medical Therapies at Discharge After Carotid Artery Stenting and Endarterectomy

Aronow

Kennedy

Wayangankar

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose-Carotid artery revascularization was previously found to incrementally reduce stroke risk among patients with carotid stenosis treated with medical therapy. However, the frequency with which optimal medical therapies are used at discharge after carotid endarterectomy (CEA) and carotid artery stenting (CAS) is not known, and the influence of patient, operator, and hospital characteristics on the likelihood of prescription is poorly understood. Methods-In a retrospective cohort study of 23 112 patients undergoing CAS or CEA between January 2007 and June 2012 at US hospitals participating in the CARE registry (Carotid Artery Revascularization and Endarterectomy), we examined antiplatelet therapy and statin utilization at discharge. Hierarchical multivariable logistic regression was used in adjusted analyses. Results-Antiplatelet agents and statins were prescribed at discharge in 99% and 78%, respectively, after CAS and 93% and 75%, respectively, after CEA. After adjustment, antiplatelet therapy was more often prescribed after CAS than CEA (odds ratio 2.4 [95% confidence interval 1.68-3.45]), but statin prescription was equally likely (odds ratio 1.11 [95% confidence interval 0.84-1.49]). Operator specialty (medical>radiology/surgery) and hospital community setting (suburban>urban>rural) independently predicted antiplatelet and statin agent use at discharge, whereas hospital geographic location (Northeast>Midwest/South>West) predicted use of statins but not antiplatelet therapy at discharge. Conclusions-US antiplatelet agent and statin discharge prescription rates were suboptimal after both CAS and CEA and varied by revascularization modality, operating physician specialty, and hospital characteristics. Improved and more uniform utilization after these procedures will be critical to the success of comprehensive stroke risk reduction efforts.

show abstract

“…After this adjustment, the rates and type of intervention (including PCI and CABG surgery) during an ACS event were identical 98 . Similarly, the adjusted rates of evidence‐based prescribing for post‐hospital secondary prevention were similar in Aboriginal and non‐Aboriginal patients 99 …”

Section: Aboriginal and Torres Strait Islander Peoplementioning

confidence: 91%

Management of acute coronary syndrome in special subgroups: female, older, diabetic and Indigenous patients

McQuillan

Thompson

2014

Medical Journal of Australia

View full text Add to dashboard Cite

Summary While the evidence base for management of acute coronary syndrome (ACS) is extensive, some subgroups have been underrepresented or excluded from relevant clinical trials. These subgroups — such as women, older people, diabetic patients and Indigenous Australians — present clinical challenges for which there is limited evidence to guide optimal therapy. Women may have a different pattern of presentation, with potential for delays in diagnosis and worse outcomes in ST‐elevation myocardial infarction, but there is no evidence that treatments affect them differently from men. Older people suffer from a high‐risk, low‐treatment paradox. This may be due to under‐appreciation of the benefits of treatments for older people, or to good clinical judgement in avoiding harm from worsening age‐related comorbidities. Patients with diabetes have a high risk of ACS and suffer worse outcomes. Moderate glycaemic control with close monitoring and avoidance of hypoglycaemia are recommended. Coronary artery bypass grafting is preferred to percutaneous coronary intervention for patients with diabetes and multivessel disease, although the latter is reasonable in single‐vessel disease. Indigenous patients have a high prevalence of coronary disease, with more frequent coronary events at a young age, a heavy load of risk factors and poor outcomes after ACS. The complex sociocultural barriers to treatment are yet to be addressed adequately.

show abstract

Evidence‐based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non‐Aboriginal patients admitted to Western Australian hospitals

Cited by 16 publications

References 32 publications

Management of stroke in the Australian Indigenous population: from hospitals to communities

Management of stroke in the Australian Indigenous population: from hospitals to communities

Prescription of Guideline-Based Medical Therapies at Discharge After Carotid Artery Stenting and Endarterectomy

Management of acute coronary syndrome in special subgroups: female, older, diabetic and Indigenous patients

Contact Info

Product

Resources

About