title: Cardiac surgery in Indigenous Australians--how wide is 'the gap'?
abstract: BACKGROUND
  Cardiovascular disease remains the leading cause of mortality in the Indigenous Australian population. Limited research exists in regards to cardiac surgery in the Aboriginal and Torres Strait Islander (ATSI) population. We aimed to investigate risk profiles, surgical pathologies, surgical management and short term outcomes in a contemporary group of patients.
  
  
  METHODS
  Variables were assessed for 557 consecutive patients who underwent surgery at our institution between August 2008 and March 2010.
  
  
  RESULTS
  19.2% (107/557) of patients were of Indigenous origin. ATSI patients were significantly younger at time of surgery (mean age 54.1±13.23 vs. 63.1±12.46; p=<0.001) with higher rates of preventable risk factors. Rheumatic heart disease (RHD) was the dominant valvular pathology observed in the Indigenous population. Significantly higher rates of left ventricular impairment and more diffuse coronary artery disease were observed in ATSI patients. A non-significant trend towards higher 30-day mortality was observed in the Indigenous population (5.6% vs. 3.1%; p=0.244).
  
  
  CONCLUSIONS
  Cardiac surgery is generally required at a younger age in the Indigenous population with patients often presenting with more advanced disease. Despite often more advanced disease, surgical outcomes do not differ significantly from non-Indigenous patients. Continued focus on preventative strategies for coronary artery disease and RHD in the Indigenous population is required.
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia; University of Queensland School of Medicine, Brisbane, Australia. Electronic address: paul_wiemers@health.qld.gov.au.
authors: Paul
authors: P
authors: Wiemers
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Lucy
authors: L
authors: Marney
authors: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
authors: Reinhold
authors: R
authors: Muller
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Matthew
authors: M
authors: Brandon
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Praveen
authors: P
authors: Kuchu
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Kasandra
authors: K
authors: Kuhlar
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Chimezie
authors: C
authors: Uchime
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Dong
authors: D
authors: Kang
authors: Mathematical Sciences School, Queensland University of Technology, Brisbane, Australia.
authors: Nicole
authors: N
authors: White
authors: Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia.
authors: Rachel
authors: R
authors: Greenup
authors: University of Queensland School of Medicine, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
authors: John F
authors: JF
authors: Fraser
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Sumit
authors: S
authors: Yadav
authors: Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia.
authors: Robert
authors: R
authors: Tam
mesh_terms: D000367:Age Factors; D001315:Australia / Q000453:epidemiology; D006348:Cardiac Surgical Procedures; D003324:Coronary Artery Disease / Q000208:ethnology / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000208:ethnology / Q000401:mortality* / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Australia; Cardiac surgical procedures; Coronary artery disease; Indigenous population; Outcomes; Rheumatic heart disease