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Nedkoff L, Greenland M, Hyun K, Htun JP, Redfern J, Stiles S, Sanfilippo F, Briffa T, Chew DP, Brieger D. Sex- and Age-Specific Differences in Risk Profiles and Early Outcomes in Adults With Acute Coronary Syndromes. Heart Lung Circ 2024; 33:332-341. [PMID: 38326135 DOI: 10.1016/j.hlc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/01/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Adults <55 years of age comprise a quarter of all acute coronary syndromes (ACS) hospitalisations. There is a paucity of data characterising this group, particularly sex differences. This study aimed to compare the clinical and risk profile of patients with ACS aged <55 years with older counterparts, and measure short-term outcomes by age and sex. METHOD The study population comprised patients with ACS enrolled in the AUS-Global Registry of Acute Coronary Events (GRACE), Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) and SNAPSHOT ACS registries. We compared clinical features and combinations of major modifiable risk factors (hypertension, smoking, dyslipidaemia, and diabetes) by sex and age group (20-54, 55-74, 75-94 years). All-cause mortality and major adverse events were identified in-hospital and at 6-months. RESULTS There were 16,658 patients included (22.3% aged 20-54 years). Among them, 20-54 year olds had the highest proportion of ST-elevation myocardial infarction compared with sex-matched older age groups. Half of 20-54 year olds were current smokers, compared with a quarter of 55-74 year olds, and had the highest prevalence of no major modifiable risk factors (14.2% women, 12.7% men) and of single risk factors (27.6% women, 29.0% men), driven by smoking. Conversely, this age group had the highest proportion of all four modifiable risk factors (6.6% women, 4.7% men). Mortality at 6 months in 20-54 year olds was similar between men (2.3%) and women (1.7%), although lower than in older age groups. CONCLUSIONS Younger adults with ACS are more likely to have either no risk factor, a single risk factor, or all four modifiable risk factors, than older patients. Targeted risk factor prevention and management is warranted in this age group.
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Affiliation(s)
- Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | - Melanie Greenland
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, Sydney, NSW, Australia
| | - Jasmin P Htun
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Samantha Stiles
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Frank Sanfilippo
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Tom Briffa
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Derek P Chew
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - David Brieger
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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2
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de Oliveira Costa J, Pearson SA, Brieger D, Lujic S, Shawon MSR, Jorm LR, van Gool K, Falster MO. In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals. Int J Equity Health 2023; 22:226. [PMID: 37872627 PMCID: PMC10594777 DOI: 10.1186/s12939-023-02030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). METHODS We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017-2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors. RESULTS Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45-0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients. CONCLUSION Our findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes.
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Affiliation(s)
- Juliana de Oliveira Costa
- Medicines Intelligence Research Program, School of Population Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
- Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
| | - Sallie-Anne Pearson
- Medicines Intelligence Research Program, School of Population Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - David Brieger
- Concord Clinical School - The University of Sydney, Sydney, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Md Shajedur Rahman Shawon
- Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation - University of Technology Sydney, Sydney, Australia
| | - Michael O Falster
- Medicines Intelligence Research Program, School of Population Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Centre for Big Data Research in Health - Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
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3
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Lopez D, Murray K, Preen DB, Sanfilippo FM, Trevenen M, Hankey GJ, Yeap BB, Golledge J, Almeida OP, Flicker L. The Hospital Frailty Risk Score Identifies Fewer Cases of Frailty in a Community-Based Cohort of Older Men Than the FRAIL Scale and Frailty Index. J Am Med Dir Assoc 2022; 23:1348-1353.e8. [PMID: 34740563 DOI: 10.1016/j.jamda.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The recently developed Hospital Frailty Risk Score (HFRS) allows ascertainment of frailty from administrative data. We aimed to compare the HFRS against the widely used FRAIL Scale and Frailty Index. DESIGN Population-based cohort study linked to Western Australian Hospital Morbidity Data Collection and Death Registrations. SETTING AND PARTICIPANTS The Health in Men Study with frailty determined at Wave 2 (2001/2004), mortality in the 1-year period following Wave 2, and disability at Wave 3 (2008). Participants were 4228 community-based men aged ≥75 years, followed until Wave 3. MEASUREMENTS We used multivariable regression to determine the association between each frailty measure and outcomes of length of stay (LOS), death, and disability. We also determined if the additional cases of frailty identified by one measure over the other was associated with these outcomes. RESULTS Of 4228 men studied, the HFRS (n = 689) identified fewer men as frail than the FRAIL Scale (n = 1648) and Frailty Index (n = 1820). In the fully adjusted models, all 3 frailty measures were associated with longer LOS and mortality, whereas only the FRAIL Scale and Frailty Index were significantly associated with disability. The additional cases of frailty identified by the FRAIL Scale and Frailty Index had longer LOS and greater risks of death and disability. The fully adjusted hazard ratio for death among the additional cases of frailty identified by the FRAIL Scale (compared to being not frail on both HFRS and FRAIL Scale) was 2.14 (95% CI 1.48-3.08). CONCLUSIONS AND IMPLICATIONS The HFRS is associated with adverse outcomes. However, it identified approximately 60% fewer men who were frail than the FRAIL Scale and Frailty Index, and the additional cases identified were also at high risks of adverse outcomes. Users of the HFRS should be aware of the differences with other frailty measures.
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Affiliation(s)
- Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Michelle Trevenen
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
| | - Osvaldo P Almeida
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Quigley A, Hutton J, Phillips G, Dreise D, Mason T, Garvey G, Paradies Y. Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments. Emerg Med Australas 2020; 33:9-18. [PMID: 33248447 DOI: 10.1111/1742-6723.13691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/24/2022]
Abstract
Aboriginal and Torres Strait Islander peoples continue to suffer adverse experiences in healthcare, with inequitable care prevalent in emergency settings. Individual, institutional and systemic factors play a significant part in these persisting healthcare disparities, with biases remaining entrenched in healthcare institutions. This includes implicit racial bias which can result in stereotyping of racial minorities and premature diagnostic closure. Furthermore, it may contribute to distrust of medical professionals resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations. The aim of this review is to analyse the effect of implicit bias on patient outcomes in the ED in international literature and explore how these studies correlate to an Australian context.
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Affiliation(s)
- Alyssa Quigley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie Hutton
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Georgina Phillips
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darlene Dreise
- Reconciliation Action Plan (RAP) Steering Committee, St Vincent's Health Australia, Brisbane, Queensland, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia.,Aboriginal Health, St Vincent's Health Australia, Brisbane, Queensland, Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
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5
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Kim KH, Park JH, Ro YS, Shin SD, Song KJ, Hong KJ, Jeong J, Lee KW, Hong WP. Association Between Post-Resuscitation Coronary Angiography With and Without Intervention and Neurological Outcomes After Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2019; 24:485-493. [DOI: 10.1080/10903127.2019.1668989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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6
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Smylie J, O'Brien K, Xavier CG, Anderson M, McKnight C, Downey B, Kelaher M. Primary care intervention to address cardiovascular disease medication health literacy among Indigenous peoples: Canadian results of a pre-post-design study. Canadian Journal of Public Health 2018; 109:117-127. [PMID: 29981069 PMCID: PMC5904243 DOI: 10.17269/s41997-018-0034-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/18/2017] [Indexed: 12/16/2022]
Abstract
CONTEXT Cardiovascular diseases (CVD) are a leading cause of illness and death for Indigenous people in Canada and globally. Appropriate medication can significantly improve health outcomes for persons diagnosed with CVD or for those at high risk of CVD. Poor health literacy has been identified as a major barrier that interferes with client understanding and taking of CVD medication. Strengthening health literacy within health services is particularly relevant in Indigenous contexts, where there are systemic barriers to accessing literacy skills. OBJECTIVE The aim of this study is to test the effect of a customized, structured health literacy educational program addressing CVD medications. METHODS Pre-post-design involves health providers and Indigenous clients at the De dwa da dehs nye>s Aboriginal Health Centre (DAHC) in Ontario, Canada. Forty-seven Indigenous clients with or at high risk of CVD received three educational sessions delivered by a trained Indigenous nurse over a 4- to 7-week period. A tablet application, pill card and booklet supported the sessions. Primary outcomes were knowledge of CVD medications and health literacy practices, which were assessed before and after the programe. RESULTS Following the program compared to before, mean medication knowledge scores were 3.3 to 6.1 times higher for the four included CVD medications. Participants were also more likely to refer to the customized pill card and booklet for information and answer questions from others regarding CVD. CONCLUSIONS This customized education program was highly effective in increasing medication knowledge and health literacy practice among Indigenous people with CVD or at risk of CVD attending the program at an urban Indigenous health centre.
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Affiliation(s)
- Janet Smylie
- Well Living House, Centre for Urban Health Solutions (CUHS) in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Kristen O'Brien
- Well Living House, Centre for Urban Health Solutions (CUHS) in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada
| | - Chloé G Xavier
- Well Living House, Centre for Urban Health Solutions (CUHS) in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada
| | - Marcia Anderson
- Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Bernice Downey
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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7
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Lopez D, Nedkoff L, Knuiman M, Hobbs MST, Briffa TG, Preen DB, Hung J, Beilby J, Mathur S, Reynolds A, Sanfilippo FM. Exploring the effects of transfers and readmissions on trends in population counts of hospital admissions for coronary heart disease: a Western Australian data linkage study. BMJ Open 2017; 7:e019226. [PMID: 29151055 PMCID: PMC5701992 DOI: 10.1136/bmjopen-2017-019226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To develop a method for categorising coronary heart disease (CHD) subtype in linked data accounting for different CHD diagnoses across records, and to compare hospital admission numbers and ratios of unlinked versus linked data for each CHD subtype over time, and across age groups and sex. DESIGN Cohort study. DATA SOURCE Person-linked hospital administrative data covering all admissions for CHD in Western Australia from 1988 to 2013. MAIN OUTCOME Ratios of (1) unlinked admission counts to contiguous admission (CA) counts (accounting for transfers), and (2) 28-day episode counts (accounting for transfers and readmissions) to CA counts stratified by CHD subtype, sex and age group. RESULTS In all CHD subtypes, the ratios changed in a linear or quadratic fashion over time and the coefficients of the trend term differed across CHD subtypes. Furthermore, for many CHD subtypes the ratios also differed by age group and sex. For example, in women aged 35-54 years, the ratio of unlinked to CA counts for non-ST elevation myocardial infarction admissions in 2000 was 1.10, and this increased in a linear fashion to 1.30 in 2013, representing an annual increase of 0.0148. CONCLUSION The use of unlinked counts in epidemiological estimates of CHD hospitalisations overestimates CHD counts. The CA and 28-day episode counts are more aligned with epidemiological studies of CHD. The degree of overestimation of counts using only unlinked counts varies in a complex manner with CHD subtype, time, sex and age group, and it is not possible to apply a simple correction factor to counts obtained from unlinked data.
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Affiliation(s)
- Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Michael S T Hobbs
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Thomas G Briffa
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - John Beilby
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sushma Mathur
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Anna Reynolds
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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8
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Wade V, Stocks N. The Use of Telehealth to Reduce Inequalities in Cardiovascular Outcomes in Australia and New Zealand: A Critical Review. Heart Lung Circ 2016; 26:331-337. [PMID: 27993487 DOI: 10.1016/j.hlc.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/07/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022]
Abstract
Telehealth, the delivery of health care services at a distance using information and communications technology, is one means of redressing inequalities in cardiovascular outcomes for disadvantaged groups in Australia. This critical review argues that there is sufficient evidence to move to larger-scale implementation of telehealth for acute cardiac, acute stroke, and cardiac rehabilitation services. For cardiovascular chronic disease and risk factor management, telehealth-based services can deliver value but the evidence is less compelling, as the outcomes of these programs are variable and depend upon the context of their implementation.
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Affiliation(s)
- Victoria Wade
- Discipline of General Practice, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.
| | - Nigel Stocks
- Discipline of General Practice, School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia
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Thompson SC, Haynes E, Woods JA, Bessarab DC, Dimer LA, Wood MM, Sanfilippo FM, Hamilton SJ, Katzenellenbogen JM. Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care. SAGE Open Med 2016; 4:2050312116681224. [PMID: 27928502 PMCID: PMC5131812 DOI: 10.1177/2050312116681224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/26/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. METHODS The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. RESULTS Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. CONCLUSION Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.
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Affiliation(s)
- Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia
| | - Emma Haynes
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia
- Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, Subiaco, WA, Australia
| | - John A Woods
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia
| | - Dawn C Bessarab
- Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Crawley, WA, Australia
| | | | | | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, WA, Australia
| | - Sandra J Hamilton
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia
| | - Judith M Katzenellenbogen
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA, Australia
- Telethon Kids Institute, Subiaco, WA, Australia
- School of Population Health, The University of Western Australia, Crawley, WA, Australia
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10
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Reading J. Confronting the Growing Crisis of Cardiovascular Disease and Heart Health Among Aboriginal Peoples in Canada. Can J Cardiol 2015; 31:1077-80. [DOI: 10.1016/j.cjca.2015.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022] Open
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11
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Katzenellenbogen JM, Woods JA, Teng THK, Thompson SC. Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review. BMC Cardiovasc Disord 2015; 15:87. [PMID: 26268309 PMCID: PMC4535416 DOI: 10.1186/s12872-015-0081-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022] Open
Abstract
Background The epidemiology of atrial fibrillation (AF) among Indigenous minorities in affluent countries is poorly delineated, despite the high cardiovascular disease burden in these populations. We undertook a systematic scoping review examining the epidemiology of AF in the Indigenous populations of Australia, Canada, New Zealand (NZ) and the United States (US). Methods PubMed, Scopus, EMBASE and CINAHL-Plus databases were systematically searched in May 2014. Supplementary full-text searches of Google Scholar and government website searches were also undertaken. Results Key findings from 27 publications with diverse aims and methods were included. Small studies from Canada and NZ suggest higher AF prevalence in Indigenous than other populations. However, this was not reflected in a large sample of US male military veterans. No data were identified on community-based incidence rates of AF in Indigenous populations. Australian and Canadian studies indicate higher first-ever and overall AF hospitalisation rates among Indigenous than other populations, at younger ages and with more comorbidity. Studies in stroke, heart failure and other clinical groups demonstrate AF as a common comorbidity, with AF possibly more prevalent at younger ages in Indigenous people. Indigenous patients have similar early post-hospitalisation adjusted mortality but higher 1-year risk-adjusted mortality than non-Indigenous patients. Conclusions No clear epidemiological pattern of AF frequency across the considered Indigenous populations emerges from the limited available evidence. AF should be included in key conditions reported in national surveillance reports, although Indigenous identifiers are required in administrative data from Canada and the US. Sufficiently powered, community-based studies of AF epidemiology in diverse Indigenous populations are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0081-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith M Katzenellenbogen
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,School of Population Health, The University of Western Australia (M431), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - John A Woods
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
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