Interventional cardiology

Timely revascularisation out of reach for people in regional Australia

Not surprisingly in a big country, there is room for improvement in access to revascularisation for patients with acute STEMI living in regional areas.

Any improvement would also preferentially benefit Aboriginal Australians who are more likely to live outside major cities, according to recently published research.

An observational study of more than 13,000 STEMI hospitalisations in NSW and the ACT between 2010 and 2014 found lower angiography and PCI rates in regional areas.

The study found 69% of people living in major cities received angiography on the day of admission compared to 36% for residents in inner regional areas and 26% for residents in more remote areas.

Similarly, 60% of residents in major cities received PCIs on admission compared with 28% of residents in inner regional areas and 17% of residents from more remote areas.

The study also found that angiography and PCI rates were lower in older patients.

At the extremes of the cohort, people aged 35-44 had angiography and PCI rates of 70% and 60% respectively compared to 42% and 34% for people aged 75 and older.

CABG rates were similar regardless of where people lived and increased in patients with increasing age to 75 years.

Age-specific population rates of STEMI hospitalisation were higher among Aboriginal than non-Aboriginal people at all ages in line with higher rates of risk factors for ischaemic heart disease, including smoking, insufficient physical activity, overweight and obesity, diabetes and high blood pressure.

However there was no difference in angiography and PCI rates between Aboriginal and non-Aboriginal people of the same age and living in the same level of geographic remoteness.

“Improving access to timely definitive revascularisation procedures is a key priority,” the study said.

The study was published in BMC Cardiovascular Disorders.

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