Interventional cardiology

We’re closing the gap on cardiac interventions – but not yet on outcomes

Closing the gap between Indigenous and non-Indigenous Australians’ cardiac health outcomes requires more than access to 24/7 cardiac catheterisation facilities, researchers say.

A far north Queensland study, presented at the European Society of Cardiology Congress, found Indigenous Australians have higher rates of PCI or cardiac surgery (OR 1.39), ventricular dysfunction (OR 1.31), and valvular disease (OR 1.93).

And while 30-day mortality was similar between the two groups, long-term all-cause mortality was higher in Aboriginal people and Torres Strait Islanders (HR 1.80).

The study said equitable access to healthcare improves outcomes but that the near-double mortality shows more work is required.

Senior investigator on the study Dr Greg Starmer, director of cardiology at the Cairns Base Hospital, told the limbic that far north Queensland had effectively removed the issue of inequitable access to specialised care seen in other regions.

It also has additional resources such as the only cardiology specific, advanced Aboriginal health worker in the state.

Yet he admits he didn’t expect the difference in outcomes to be so great once the access to care issue was resolved.

“We talk about closing the gap and whilst we know there is this mortality gap, and we know cardiovascular disease is a key component of that, understanding why that is still eludes us.”

“So we have managed to overcome a lot of the barriers and still we see the disease is absolutely incredible. Now that we have identified that we are planning to look at a more granular level as to why but a theory is that there is actually a genetic component which is exacerbated by early risk factors.”

“We see people in their 20s with advanced coronary disease which just should not be possible so there is clearly a genetic player which is not really well understood.”

Dr Starmer said statewide data also showed Indigenous patients access their first cath lab intervention about 12 years earlier than non-Indigenous patients.

“We are going to start looking at chest pain presentations in the ED in Indigenous patients – with calcium scores and CTs to see what the burden of disease is in a somewhat self-selected but undifferentiated group…and ways we can streamline our approach to care in ATSI patients.”

For example, clinical pathways had to be tailored to the local population.

“We all know from working in this part of the world that being 30 and Aboriginal or Torres Strait Islander is risk enough.”

“There are a lot of myths and commentary out there but not a lot of good data …and this extends to minority groups around the world when you try to find out rates of PCI or surgery.”

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