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- Title
Management of Indigenous patients presenting with non ST-segment elevation acute coronary syndrome in South Australia: a retrospective cohort study.
- Authors
Roe, Y. L.; Esterman, A.; McDermott, R.; Zeitz, C.
- Abstract
Aim 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.
- Subjects
AUSTRALIA; CARDIOVASCULAR disease diagnosis; HYPERTENSION; TREATMENT of acute coronary syndrome; AGE distribution; ANGIOGRAPHY; CONFIDENCE intervals; ELECTROCARDIOGRAPHY; HEMODIALYSIS; HOSPITALS; HOSPITAL emergency services; INDIGENOUS peoples; INTERNAL medicine; MEDICAL protocols; METROPOLITAN areas; MULTIVARIATE analysis; RISK assessment; DECISION making in clinical medicine; DISEASE management; DISCHARGE planning; DATA analysis software; ACUTE coronary syndrome; DIAGNOSIS
- Publication
Internal Medicine Journal, 2016, Vol 46, Issue 2, p202
- ISSN
1444-0903
- Publication type
Article
- DOI
10.1111/imj.12949