Cardiac procedures in ST-segment-elevation myocardial infarction - the influence of age, geography and Aboriginality
Lee K Taylor1, Michael A Nelson2, Marianne Gale3
1Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia.
Insights
Timely reperfusion for ST-segment elevation myocardial infarction (STEMI) is crucial. This study found that older patients and those in regional areas have reduced access to timely reperfusion therapies like PCI, highlighting a gap in care for Aboriginal people with STEMI.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) requires prompt blood flow restoration to minimize heart damage and improve outcomes.
- Demographic factors influence hospitalisation rates and treatment timeliness for STEMI.
Purpose of the Study:
- To examine the association between demographic factors and STEMI hospitalisation rates.
- To analyze the time to reperfusion therapies (angiography, Percutaneous Coronary Intervention (PCI), Coronary Artery Bypass Graft (CABG)) for STEMI patients in NSW and ACT, Australia.
Main Methods:
- Observational cohort study utilizing linked population health data from NSW and ACT.
- Inclusion of hospitalisation records and Medicare Benefits Schedule (MBS) data for STEMI patients aged 35 and over (July 2010 - June 2014).
- Survival analysis with competing risk of death was employed to determine time to cardiac procedures.
Main Results:
- STEMI hospitalisations were more common in males (71%) and older individuals (55% aged 65+).
- Reperfusion rates (angiography, PCI) decreased significantly with age and were lower in regional areas compared to major cities.
- Aboriginal people with STEMI were younger, more likely to reside outside major cities, and had similar reperfusion rates to non-Aboriginal people when controlling for age and remoteness.
Conclusions:
- There is a critical need to enhance access to timely reperfusion therapies for STEMI, particularly for older patients and those in regional areas.
- Aboriginal people with STEMI face significant disparities in accessing definitive revascularisation outside major cities.
- Improving regional access to timely reperfusion is essential to reduce cardiovascular outcome gaps between Aboriginal and non-Aboriginal populations.
Background:
Timely restoration of bloodflow acute ST-segment elevation myocardial infarction (STEMI) reduces myocardial damage and improves prognosis. The objective of this study was describe the association of demographic factors with hospitalisation rates for STEMI and time to angiography, Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia.
Methods:
This was an observational cohort study using linked population health data. We used linked records of NSW and the ACT hospitalisations and the Australian Government Medicare Benefits Schedule (MBS) for persons aged 35 and over hospitalised with STEMI in the period 1 July 2010 to 30 June 2014. Survival analysis was used to determine the time between STEMI admission and angiography, PCI and CABG, with a competing risk of death without cardiac procedure.
Results:
Of 13,117 STEMI hospitalisations, 71% were among males; 55% were 65-plus years; 64% lived in major cities, and 2.6% were Aboriginal people. STEMI hospitalisation occurred at a younger age in males than females. Angiography and PCI rates decreased with age: angiography 69% vs 42% and PCI 60% vs 34% on day 0 for ages 35-44 and 75-plus respectively. Lower angiography and PCI rates and higher CABG rates were observed outside major cities. Aboriginal people with STEMI were younger and more likely to live outside a major city. Angiography, PCI and CABG rates were similar for Aboriginal and non-Aboriginal people of the same age and remoteness area.
Conclusions:
There is a need to improve access to definitive revascularisation for STEMI among appropriately selected older patients and in regional areas. Aboriginal people with STEMI, as a population, are disproportionately affected by access to definitive revascularisation outside major cities. Improving access to timely definitive revascularisation in regional areas may assist in closing the gap in cardiovascular outcomes between Aboriginal and non-Aboriginal people.
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