Acute coronary syndromes in indigenous Australians: opportunities for improving outcomes across the continuum of care.
BACKGROUND
Amongst a long list of health issues driving the disparity experienced by Indigenous Australians, cardiovascular disease (CVD) remains the primary target. It is the principal cause of death and of excess death among Indigenous people in Australia, and accounts for almost one-third of the life expectancy gap. Most attention has focused on the higher burden of traditional risk factors experienced by Indigenous people to explain CVD disparity. Far less attention has focused on the quality and outcomes of health system performance in explaining these differentials. The CASPA study was a retrospective, mixed-methods clinical registry and quality improvement program established in the NT of Australia, focused on the patterns, burdens, provision of care, experience of services, adverse outcomes and their determinants among 492 patients (214 Indigenous and 278 non-Indigenous).


RESULTS
Indigenous patients were significantly younger and more likely to have existing CVD risk factors and co-morbid chronic disease. During hospitalisation they received similar rates of evidence-based care with the exception of lower rates of diagnostic angiography (36.2% vs. 47.6%, p=0.012), lower rates of in-patient cardiac rehabilitation (8.9% vs. 15.3%, p=0.03) and lower prescription of discharge statin (44.8% vs. 57.8%, p=0.006). Indigenous patients were more likely to die during two years of follow-up (30% vs. 17.8%, p=0.002). Both Indigenous and non-Indigenous patients were similarly under-prescribed evidence based therapy after discharge. Exploratory qualitative examination of the experience of Indigenous patients in Alice Springs identified significant barriers to care across the continuum.


CONCLUSIONS
Improvements in the delivery of known effective therapies will make a significant impact on adverse outcomes in Indigenous and non-Indigenous patients alike. Comprehensive and sustained prospective data collection to compliment system reform is essential to improve outcomes and reduce disparity in CVD outcomes experienced by Indigenous Australians.
Brown
Alex
A
Centre for Indigenous Vascular and Diabetes Research, BakerIDI Heart and Diabetes Institute, Alice Springs, NT, Australia. alex.brown@bakeridi.edu.au
D054058:Acute Coronary Syndrome / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia; D003131:Combined Modality Therapy; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004638:Emergency Treatment / Q000592:standards / Q000639:trends; D005260:Female; D006303:Health Services, Indigenous / Q000592:standards / Q000639:trends; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D044382:Population Groups; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D012737:Sex Factors; D016019:Survival Analysis