title: Management of Indigenous patients presenting with non ST-segment elevation acute coronary syndrome in South Australia: a retrospective cohort study.
abstract: OBJECTIVE
  Using Australian guidelines for management of acute coronary syndromes, we assessed the probability of an Indigenous patient receiving interventional and therapeutic care after presenting in two metropolitan hospitals.
  
  
  METHODS
  A retrospective case note review of patients admitted through two Adelaide public tertiary hospital emergency departments from December 2007 to December 2009. The study cohort was 488 patients with high-risk clinical features without ST-segment elevation.
  
  
  RESULTS
  Indigenous patients were significantly younger, present later in the disease process and have a higher burden of cardiovascular risk factors when compared with non-Indigenous patients. Indigenous patients were 54% more likely to receive angiography (Risk ratios (RR) = 1.54; 95% CI 1.31; 1.81) than non-Indigenous patients, however, this difference disappeared after adjustment for age, sex and propensity score. Indigenous patients were 20% more likely to receive the recommended medications (RR = 1.19, 95% CI 1.01; 1.40) compared with non-Indigenous patients. Patients over 65 years were 53% less likely to receive an angiogram (RR = 0.47, 95% CI 0.38; 0.56) and were 35% less likely to receive the recommended medications (RR = 0.65, 95% CI 0.54; 0.78) than a patient at the ages of 18-49. Women were almost 20% less likely to receive an angiogram (RR = 0.81, 95% CI 0.66; 0.99) and 20% less likely to receive the recommended medications (RR = 0.80, 95% CI 0.71; 0.91) when compared with men. The likelihood of receiving medications on discharge was significantly influenced by age, gender, ethnicity, comorbid burden and revascularisation.
  
  
  CONCLUSIONS
  The younger age and significantly higher-risk profile of Indigenous adults presenting to SA hospitals with acute coronary syndromes appears to lead to different management decisions, which may well be led by patient factors. Many of these risk conditions can be better managed in the primary care setting.
authors.affiliation: Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia.
authors.forename: Y L
authors.initials: YL
authors.lastname: Roe
authors.affiliation: School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia.
authors.forename: A
authors.initials: A
authors.lastname: Esterman
authors.affiliation: Faculty of Medicine, Health and Molecular Sciences, James Cook University, Cairns, Queensland, Australia.
authors.forename: R
authors.initials: R
authors.lastname: McDermott
authors.affiliation: Division of Medicine, The Queen Elizabeth Hospital, Woodville, SA, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Zeitz
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013021:South Australia / Q000208:ethnology
keywords: Indigenous; acute coronary syndromes; age; diagnostic coronary angiography; gender; therapeutic intervention