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A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia

Marcus K Ilton, Warren F Walsh, Alex D H Brown, Philip A Tideman, Christopher J Zeitz and Jinty Wilson
Med J Aust 2014; 200 (11): 639-643. || doi: 10.5694/mja12.11175

Summary

  • Aboriginal and Torres Strait Islander patients with acute coronary syndromes (ACS) experience lower intervention rates and poorer outcomes compared with non-Indigenous patients.
  • A broad range of geographical, cultural and systemic factors contribute to delays and suboptimal treatment for ACS.
  • Every Indigenous ACS patient, regardless of where they live, should be able to expect a coordinated, patient-centred pathway of care provided by designated provider clinical networks and supported by Indigenous cardiac coordinators, Aboriginal liaison officers (ALOs) and health workers.
  • These designated provider clinical networks provide:
    • appropriate prehospital and inhospital treatment
    • an individualised patient care plan developed jointly with the patient and his or her family
    • culturally appropriate education initiated within the hospital setting and involving families with support from ALOs
    • effective follow-up care and access to relevant secondary prevention programs.
  • We outline generic pathways to provide policymakers, health planners and health care providers with a framework for ACS diagnosis and management that can be implemented across the diverse settings in which Aboriginal and Torres Strait Islander people reside and their care is delivered, in order to optimise care and assertively address the current disparities in outcomes.

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  • Marcus K Ilton1
  • Warren F Walsh2
  • Alex D H Brown3,4
  • Philip A Tideman5,6
  • Christopher J Zeitz7
  • Jinty Wilson8

  • 1 Cardiology Department, Royal Darwin Hospital, Darwin, NT.
  • 2 Department of Cardiology, Prince of Wales Hospital, Sydney, NSW.
  • 3 South Australian Health and Medical Research Institute, Adelaide, SA.
  • 4 School of Population Health, University of South Australia, Adelaide, SA.
  • 5 Integrated Cardiovascular Clinical Network (iCCnet), Country Health SA Local Health Network, Adelaide, SA.
  • 6 Southern Adelaide Local Health Network, Adelaide, SA.
  • 7 University of Adelaide, Adelaide, SA.
  • 8 Clinical Programs, National Heart Foundation of Australia, Melbourne, VIC.


Acknowledgements: 

Marcus Ilton, Warren Walsh, Alex Brown, Philip Tideman and Christopher Zeitz are members of the subcommittee for the National Heart Foundation of Australia's ACS Implementation and Advocacy Working Group. We thank Karen Uhlmann and Rachelle Foreman of the National Heart Foundation of Australia, Queensland, for coordination of the Working Group and subcommittees and Eleanor Clune, Senior Project Officer, National Heart Foundation of Australia, for her contribution as a clinical writer.

Competing interests:

Marcus Ilton is a Board member of the National Heart Foundation of Australia on an honorary basis. He received a Heart Foundation Focus Grant 2013 (100368). Alex Brown received funding for an investigator-driven research project from Pfizer (2004–2005); travel support from Alphapharm in 2007 and 2008; and recently sat on a research advisory board for an investigator-initiated study (the VIPER-BP study) sponsored by Novartis.

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