Disparities between Aboriginal & non-Aboriginal South Australians in acute cardiac care

Heart Foundation funded research for the ‘Evaluation of in-hospital disparities between Aboriginal and non-Aboriginal South Australians in acute cardiovascular care’ study, led by Dr Rosanna Tavella at Adelaide University, has been published in the Medical Journal of Australia today.

The study identified significant disparities in the process of patient assessment leading up to receipt of an angiogram test. However reassuringly for those who did receive an angiogram, receipt of ongoing management was similar.

This study has mapped the pathway to angiography receipt, providing a clear picture of how this diagnostic test is accessed. An angiogram is the ‘gold standard’ test to enable doctors to diagnose the existence and extent of disease (or narrowing) of a patient’s coronary arteries – the cause of heart attacks – allowing patients to receive life-saving treatment earlier.

Dr Rosanna Tavella, the principal investigator of the study, said previous research from the Australian Institute of Health and Welfare1 had shown 40% lower rates of angiogram and 20-40 per cent lower rates of invasive management in Aboriginal patients, raising awareness amongst government and healthcare bodies to initiate collaborative solutions.

This study, conducted in 4 metropolitan Adelaide hospitals, involving the collaborative efforts of the Heart Foundation, SA Health’s State-wide Cardiac Clinical Network and an expert workgroup of leading SA cardiologists representing each Local Health Service, SAHMRI researchers and Aboriginal Health professionals.

The study combined SA Health data and medical record review of all Aboriginal admissions to assess the potential influence of Aboriginal status on receipt of invasive management and further understand the disparities in access to angiography.

Professor Alex Brown SAHMRI Deputy Director and program leader, Aboriginal research explained; “After adjusting for age and degree of risk, the Study found that Aboriginal people were less likely to receive an angiogram than non-Aboriginal patients”.

“Aboriginal patients were younger, more likely to be female, had higher rates of smoking, diabetes, renal disease and high cholesterol than non-Aboriginal patients. Of all patients, those not receiving an angiogram were more likely to be older, have existing heart failure, respiratory disease and renal failure. However without these factors, just being Aboriginal was an independent predictor of not receiving an angiogram,” Professor Brown explained.

Of the Aboriginal patients who did not receive an angiogram in this study, 56 per cent of cases were attributed to patient-related factors or had no clear justification provided, compared to only 17% of non-Aboriginal patients.

Aboriginal patients had a high rate of being ‘discharged against medical advice’ (10.5 per cent) raising concerns about the barriers experienced by Aboriginal people in accessing quality care including; poor engagement and communication, a lack of coordinated care or inadequate cultural insight of health care providers which results in isolation, fear and disengagement by patients.

On a positive note Dr Tavella said, “Importantly, the research demonstrates that those Aboriginal patients who did receive an angiogram, were as likely as non-Aboriginal patients to receive an angioplasty or bypass surgery, medications on discharge and referral to cardiac rehabilitation.”

“These very important results show that improvements can be made in the assessment of patients with a suspected heart attack to ensure they receive an angiogram as soon as possible and has the potential to save hundreds of lives each year,” Dr Tavella said.

Other key findings include:
– Symptom duration before presenting to hospital was a median of 162 minutes and was similar between Aboriginal and non-Aboriginal patients.
– Aboriginal patients who had a visit by an Aboriginal liaison officer while in hospital or who arrived at hospital with a friend or member of their family were more likely to receive an angiogram.

Dr Amanda Rischbieth, CEO Heart Foundation SA said, “these findings are another example of the importance of funding heart research in Australia.”

“Heart disease remains our number one killer and with the support of our generous donors and substantial commitment from the State Government, we will ensure our leading researchers continue to achieve significant results in tackling this health burden,” Dr Rischbieth added.

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Ryan Fritz

Ryan Fritz started The Advocate in 2014 to provide not-for-profits and charities with another media platform to tell their worthwhile hard news stories and opinion pieces effortlessly. In 2020, Ryan formed a team of volunteer journalists to help spread even more high-quality stories from the third sector. He also has over 10 years of experience as a media and communications professional for not-for-profits and charities.

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