title: Management of the acute cardiac patient in the Australian rural setting: a 12 month retrospective study.
abstract: BACKGROUND
  Rural cardiac patients may require transfer to tertiary health services for ongoing acute cardiac management. The time required to transfer is a consideration in determining appropriate clinical care. There is little published data reporting acute cardiac management in the Australian regional setting that reviews factors determining transfer to a tertiary centre.
  
  
  OBJECTIVE
  This paper reports the findings of a quantitative, retrospective study conducted to identify demographic differences and potential predictors to urban transfer for ongoing acute cardiac management for patients presenting to a regional hospital with suspected acute myocardial infarction.
  
  
  METHODS
  Using a purpose designed tool an audit of 204 files from June 2009 to July 2010 was conducted for all patients admitted to a regional hospital having a discharge diagnosis of acute myocardial infarction or angina. Patient demographics, clinical outcomes, concordance with treatment guidelines, and possible predictors of treatment decisions were investigated.
  
  
  RESULTS
  Patients younger than 65 years (p<0.001), unemployed (p<0.01) and with acute electrocardiograph changes (p<0.01) were more likely to be transferred to a tertiary centre. Treatment guidelines concordance for acute cardiac care ranged from 70% to 79% for all patients.
  
  
  CONCLUSIONS
  Although presenting patients were treated in a timely manner consistent with national guidelines, to be younger, unemployed or have electrocardiograph changes was a greater predictor to urban transfer. It is unknown if these differences in transferring or not to a tertiary centre contribute to poorer long-term cardiac outcomes for rural patients. Further evaluations are warranted.
authors.affiliation: La Trobe Rural Health School, La Trobe University, Wodonga 3689, Australia. Electronic address: s.clune@latrobe.edu.au.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Clune
authors.affiliation: School of Nursing & Midwifery, La Trobe University, Bundoora 3086, Australia. Electronic address: J.Blackford@latrobe.edu.au.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Blackford
authors.affiliation: La Trobe University Clinical School of Nursing @ Austin Health, Heidelberg 3084, Australia. Electronic address: maria.murphy@latrobe.edu.au.
authors.forename: Maria
authors.initials: M
authors.lastname: Murphy
mesh_terms: D001315:Australia; D006764:Hospitals, Community; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012423:Rural Health; D019035:Rural Health Services; D062606:Tertiary Care Centers
keywords: Australia; Myocardial infarction; Regional; Rural health