Background:
Ischemic heart disease is a major contributing factor to the significant mortality and disease burden gap for Indigenous Australians. The current study is a contemporary analysis of Indigenous and non-Indigenous acute myocardial infarction (AMI) patients in regards to clinical features, in-hospital outcomes and performance measures.
Methods:
All consecutive patients undergoing coronary angiography for AMI in South Australian public hospitals from January 2012 [[Unable to Display Character: –]] December 2013 were captured. AMI patients (as per Third Universal AMI Definition) were analyzed according to ethnicity (Indigenous/Non-Indigenous). Data was maintained by the Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR
®
CathPCI
®
Registry.
Results:
From 10,469 coronary angiograms performed, the prevalence of Indigenous patients was 4%. The frequency of AMI was higher in Indigenous (n=212) vs. Non-Indigenous (n=3636) patients (50% vs. 36%, p <0.01), despite Indigenous patients being younger by 15 years (50±12 vs. 65±13, p<0.01) and also more likely to be female (41% vs. 29%, p<0.01). Age adjusted analyses revealed a higher prevalence of comorbidities in Indigenous patients including: smoker (66% vs. 34%, p<0.01), hypertension (70% vs. 64%, p<0.01), dyslipidaemia (71% vs. 59%, p<0.01), diabetes (58% vs. 29%, p<0.01), and prior AMI (26% vs. 20%, p<0.01). There were fewer ST elevation myocardial infarcts (STEMI) (33% vs. 39%, p<0.01) but higher rates of hospital transfers (43% 25%, p<0.01) amongst Indigenous patients. Percutaneous coronary intervention (PCI) was less frequently utilized in Indigenous patients (46% vs. 51%, p<0.01), including few Indigenous STEMI patients undergoing primary PCI (18% vs. 53%, <0.01). In-hospital outcomes were similar between Indigenous and non-Indigenous patients, including bleeding complications (0.9% vs. 1.5%, p>0.05) and mortality (2.5% vs. 2.9%, p>0.05), although the relative risk of death adjusted for comorbidities was higher among Indigenous patients (2.7, (0.8-8.0) vs. 0.4, (0.1-1.3,) p>0.05). Discharge therapies were mostly similar in Indigenous vs. non-Indigenous patients including aspirin (91% vs. 84%, p>0.05), beta-blockers (75% vs. 62%, p<0.01), statin (90% vs. 83%, p<0.01), ACE-inhibitor/angiotensin receptor blocker (81% vs. 78%, p>0.05), or referral to cardiac rehab (44% vs. 48%, p>0.05).
Conclusion:
Indigenous Australians present for angiography with AMI 15 years earlier than non-Indigenous Australians. Despite this, they have a greater incidence of comorbidities, are more often transferred but PCI is less often utilised. Although in-hospital complications do not differ, there is room for improvement given a higher risk of death. Furthermore, evaluation of medication compliance and access to medications post discharge may provide further insight into disease burden.
Prediction of Hospital Acute Myocardial Infarction and Heart Failure 30-Day Mortality Rates Using Publicly Reported Performance Measures