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A Multidisciplinary and Culturally Appropriate Model of Care in Cardiac Outreach Clinic Improves Indigenous Patient Continuity of Care
Conclusions: In our population with VCFS, the commonest cardiac abnormality was a conotruncal defect and the commonest non-cardiac diagnosis was psychiatric (35%). As in other recent case studies, we found an apparent association with treatment resistant schizophrenia. This highlights the importance of regular follow-up and management in a specialist centre. http://dx.doi.org/10.1016/j.hlc.2012.05.742 Indigenous 729 A Retrospective Analysis on the Differences in Demographic Characteristics and Management Outcomes Between the Indigenous and Non-Indigenous Patients Admitted with Acute Coronary Syndromes (ACS) At Royal Darwin Hospital (RDH) Between 2010 and 2011 R. Prakash ∗ , R. Adams, M. Ilton, N. Kangaharan, G. Chacko Royal Darwin Hospital, Australia Background: Patient with ACS at RDH include both Indigenous and non-Indigenous populations. Various demographic and sociocultural differences exist between the two populations although similar guideline based therapy are provided. Objective: To ascertain the differences in the baseline characteristics, risk factor profile, revascularisation procedures between the two populations. Methods: Patients with ACS who underwent coronary angiography at RDH between the 31st June 2011 and 30th July 2011 were selected and data compiled from the RDH cardiac catheter lab database. Baseline demography, risk factor profile, revascularisation procedures were determined. Basic demographic analysis were performed with further statistical analysis by two=tailed Chi-Square test to assess statistical significance between the variables. Results: 254 patients were sampled of which 49% were Indigenous in origin. Indigenous patients were younger with nearly 60% of the population below the age of 50. Incidences of ACS among the Indigenous patients were (633 cases/100,000) compared to (195 cases/100,000) amongst the non-Indigenous patients. Traditional cardiovascular risk factors were more prevalent among the Indigenous population. Indigenous patients underwent more CABG procedures (12% vs 8%) but less PCI procedures (16% vs 20%) although this was not found to be statistically significant. Conclusions: Nearly half of ACS patients at RDH were Indigenous in origin with approximately two of three below the age of 50. Indigenous patients had three-fold more incidence of ACS compared to non-Indigenous patients. Both populations underwent relatively similar proportions of various revascularisation procedures. More health care initiatives are required to bridge the gap between these populations. http://dx.doi.org/10.1016/j.hlc.2012.05.743
Abstracts CSANZ 2012 Abstracts
S301
730 A Multidisciplinary and Culturally Appropriate Model of Care in Cardiac Outreach Clinic Improves Indigenous Patient Continuity of Care V. Bryce 1,∗ , C. Sullivan 2,3,4 , C. Hall 2,3,4 , W. Wang 2,3,4 , A. Ng 2,3,4 1 Princess
Alexandra Hospital Brisbane, Australia Cardiac Clinical Network Brisbane, Australia 3 University of South Australia Adelaide, Australia 4 Princess Alexandra Hospital University of Queensland Brisbane, Australia 2 Southern
Background: Cardiovascular disease (CVD) is the leading cause of mortality in Indigenous Australians. Access to culturally sensitive health services is disproportionate to their health care needs and contributes to these poor outcomes. Aim: A project supported by the Southern Area Cardiac Clinical Network (QLD) developed a model of care that aligned with cultural safety and competence concepts. Methods: Purposive sampling of medical, nursing, pharmacy and aboriginal health care workers through qualitative semi structured focus group sessions was undertaken. Three investigators undertook thematic analysis of focus groups using a content analysis approach achieving consensus and developing the thematic schema. Results: The emerging themes from the focus group data analysis support the implemented multidisciplinary team (MDT) model of care. Themes include clinical and cultural exchange, stereotyping and racism, cultural safety and competency, respecting diversity, inclusion of Aboriginal health care worker/community/family, MDT approach. Summed up by these quotes. “We can teach them (health care providers) about our culture and what’s appropriate for our mob” – “patients are more likely to do what the doctor says. . ..” – “All clinics should be run this way”. Clinic attendance continues to support this model. Total Indigenous clinic attendance in 2010 (pre-intervention) improved from 76% to 82.24% in 2011 (post-intervention) Conclusions: The integration of the MDT model with full inclusion of the Aboriginal health care worker is an effective approach to reduce fragmentation and achieve continuity and culturally appropriate coordinated care for indigenous people with CVD.
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316
S302
Abstracts CSANZ 2012 Abstracts
Heart, Lung and Circulation 2012;21:S143–S316
ABSTRACTS
Conclusions: There are fewer admissions with AF for Maori than expected in the Waikato. Maori inpatients with AF are younger, stay longer and are more likely to have AF as a secondary rather than primary diagnosis when compared to non-Maori. http://dx.doi.org/10.1016/j.hlc.2012.05.745 732 Heart Failure, Ventricular Dysfunction and Risk Factor Prevalence in a Young Aboriginal Population: The Heart of the Heart Study M. McGrady 1,∗ , H. Krum 1 , M. Carrington 2 , S. Stewart 2 , C. Zeitz 3 , G. Lee 1,2 , T. Marwick 4 , B. Haluska 5 , A. Brown 2 1 Monash
http://dx.doi.org/10.1016/j.hlc.2012.05.744 731 Differences Among Maori And Non-Maori Inpatients With Atrial Fibrillation M. Webber ∗ , M. Mannakarra, J. Swampillai, I. Gray, M. Stiles Waikato Hospital, Waikato DHB, Hamilton, New Zealand Background: Atrial fibrillation (AF) precipitates or complicates hospital admission and carries significant morbidity and mortality. International data suggest there may be discrepancies in AF patient characteristics and prevalence between ethnic groups. We aim to describe the characteristics of inpatients with AF and identify disparities between Maori and non-Maori that may guide therapy. Method: Data was collected from Waikato District Health Board clinical coding for hospital admissions between 1/1/2001 and 31/12/2010 coded “atrial fibrillation” as a primary or secondary diagnosis. Results: Of 24,684 admissions, 679 were excluded due to no ethnicity data. Maori comprised 19.7% of admissions; the expected proportion for the Waikato region is 21% (p < 0.001). Maori (n = 4722) n Age ≥ 65 years, 2261 n = 17,864 (44%) Female gender, 2133 n = 10,936 (46%) 5 (0–881) Median length of stay (days), 5 (range 0–1030) 862 AF as primary diagnosis, 5870 (24%) 2663 Admissions in first five years, n = 13,135 (55%)
Non-Maori (n = 19283)
%
n
%
P value
48
15603
81
<0.001
45
8803
46
0.6
–
<0.001
–
0 (0–1030)
University, Australia IDI Heart and Diabetes Research Institute, Australia 3 University of Adelaide, Australia 4 Clevland Clinic, United States 5 University of Queensland, Australia 2 Baker
18
5008
26
<0.001
56
10,472
54
<0.001
Where AF was a secondary diagnosis the most common primary diagnoses were infection/inflammation (3125), congestive heart failure (2103), and myocardial infarction (2048).
Purpose: Heart failure (HF) affects Aboriginal Australians younger and mortality is higher. Evaluation has been scarce, thus we sought to document HF, asymptomatic left ventricular dysfunction (ALVD) and risk factor prevalence in an Indigenous population. Methods: Comprehensive cardiovascular assessments, including clinical examination, echocardiography, B-type natriuretic peptide (BNP), and medical record review were used to determine HF status (independently adjudicated), ALVD and risk factor profile in participants enrolled across 6 Indigenous communities. Results: 436 participants (mean age 44 ± 14years, 64% women) enrolled, 23 were diagnosed with HF (5%; 95%CI: 3–8%), only eight had a pre-existing diagnosis. ALVD was observed in 53 participants (systolic 11, diastolic 42) (13%; 95%CI: 9–16%). HF risk factor prevalence was: hypertension 42% (95%CI: 37–46%), diabetes 34% (95%CI: 30–39%), coronary artery disease (CAD) 7% (95%CI: 5–10%), obesity (BMI ≥ 30 kg/m2 ) 42% (95%CI: 38–47%), and rheumatic heart disease or previous acute rheumatic fever 7% (95%CI: 5–10%). In logistic regression (adjusted for age, gender), HF was associated with CAD (9.6, p < 0.0001), diabetes (OR 5.6, p = 0.001), hypertension (OR 5.0, p = 0.005), and obesity (OR 2.9, p = 0.02). In multivariate models (adjusted for age, sex, HF risk factors, BNP, creatinine) severity of systolic dysfunction was independently associated with male gender (p = 0.04) and BNP (p = 0.003) and diastolic dysfunction with age (p < 0.0001), diabetes (p = 0.008) and BNP (p = 0.005). Conclusion: HF (much undiagnosed), ALVD, and risk factors in this young population were high. BNP was independently associated with systolic and diastolic dysfunction. These findings may have implications for developing strategies to improve the poorer outcomes within Indigenous populations. http://dx.doi.org/10.1016/j.hlc.2012.05.746
Abstracts CSANZ 2012 Abstracts
S301
730 A Multidisciplinary and Culturally Appropriate Model of Care in Cardiac Outreach Clinic Improves Indigenous Patient Continuity of Care V. Bryce 1,∗ , C. Sullivan 2,3,4 , C. Hall 2,3,4 , W. Wang 2,3,4 , A. Ng 2,3,4 1 Princess
Alexandra Hospital Brisbane, Australia Cardiac Clinical Network Brisbane, Australia 3 University of South Australia Adelaide, Australia 4 Princess Alexandra Hospital University of Queensland Brisbane, Australia 2 Southern
Background: Cardiovascular disease (CVD) is the leading cause of mortality in Indigenous Australians. Access to culturally sensitive health services is disproportionate to their health care needs and contributes to these poor outcomes. Aim: A project supported by the Southern Area Cardiac Clinical Network (QLD) developed a model of care that aligned with cultural safety and competence concepts. Methods: Purposive sampling of medical, nursing, pharmacy and aboriginal health care workers through qualitative semi structured focus group sessions was undertaken. Three investigators undertook thematic analysis of focus groups using a content analysis approach achieving consensus and developing the thematic schema. Results: The emerging themes from the focus group data analysis support the implemented multidisciplinary team (MDT) model of care. Themes include clinical and cultural exchange, stereotyping and racism, cultural safety and competency, respecting diversity, inclusion of Aboriginal health care worker/community/family, MDT approach. Summed up by these quotes. “We can teach them (health care providers) about our culture and what’s appropriate for our mob” – “patients are more likely to do what the doctor says. . ..” – “All clinics should be run this way”. Clinic attendance continues to support this model. Total Indigenous clinic attendance in 2010 (pre-intervention) improved from 76% to 82.24% in 2011 (post-intervention) Conclusions: The integration of the MDT model with full inclusion of the Aboriginal health care worker is an effective approach to reduce fragmentation and achieve continuity and culturally appropriate coordinated care for indigenous people with CVD.
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316
S302
Abstracts CSANZ 2012 Abstracts
Heart, Lung and Circulation 2012;21:S143–S316
ABSTRACTS
Conclusions: There are fewer admissions with AF for Maori than expected in the Waikato. Maori inpatients with AF are younger, stay longer and are more likely to have AF as a secondary rather than primary diagnosis when compared to non-Maori. http://dx.doi.org/10.1016/j.hlc.2012.05.745 732 Heart Failure, Ventricular Dysfunction and Risk Factor Prevalence in a Young Aboriginal Population: The Heart of the Heart Study M. McGrady 1,∗ , H. Krum 1 , M. Carrington 2 , S. Stewart 2 , C. Zeitz 3 , G. Lee 1,2 , T. Marwick 4 , B. Haluska 5 , A. Brown 2 1 Monash
http://dx.doi.org/10.1016/j.hlc.2012.05.744 731 Differences Among Maori And Non-Maori Inpatients With Atrial Fibrillation M. Webber ∗ , M. Mannakarra, J. Swampillai, I. Gray, M. Stiles Waikato Hospital, Waikato DHB, Hamilton, New Zealand Background: Atrial fibrillation (AF) precipitates or complicates hospital admission and carries significant morbidity and mortality. International data suggest there may be discrepancies in AF patient characteristics and prevalence between ethnic groups. We aim to describe the characteristics of inpatients with AF and identify disparities between Maori and non-Maori that may guide therapy. Method: Data was collected from Waikato District Health Board clinical coding for hospital admissions between 1/1/2001 and 31/12/2010 coded “atrial fibrillation” as a primary or secondary diagnosis. Results: Of 24,684 admissions, 679 were excluded due to no ethnicity data. Maori comprised 19.7% of admissions; the expected proportion for the Waikato region is 21% (p < 0.001). Maori (n = 4722) n Age ≥ 65 years, 2261 n = 17,864 (44%) Female gender, 2133 n = 10,936 (46%) 5 (0–881) Median length of stay (days), 5 (range 0–1030) 862 AF as primary diagnosis, 5870 (24%) 2663 Admissions in first five years, n = 13,135 (55%)
Non-Maori (n = 19283)
%
n
%
P value
48
15603
81
<0.001
45
8803
46
0.6
–
<0.001
–
0 (0–1030)
University, Australia IDI Heart and Diabetes Research Institute, Australia 3 University of Adelaide, Australia 4 Clevland Clinic, United States 5 University of Queensland, Australia 2 Baker
18
5008
26
<0.001
56
10,472
54
<0.001
Where AF was a secondary diagnosis the most common primary diagnoses were infection/inflammation (3125), congestive heart failure (2103), and myocardial infarction (2048).
Purpose: Heart failure (HF) affects Aboriginal Australians younger and mortality is higher. Evaluation has been scarce, thus we sought to document HF, asymptomatic left ventricular dysfunction (ALVD) and risk factor prevalence in an Indigenous population. Methods: Comprehensive cardiovascular assessments, including clinical examination, echocardiography, B-type natriuretic peptide (BNP), and medical record review were used to determine HF status (independently adjudicated), ALVD and risk factor profile in participants enrolled across 6 Indigenous communities. Results: 436 participants (mean age 44 ± 14years, 64% women) enrolled, 23 were diagnosed with HF (5%; 95%CI: 3–8%), only eight had a pre-existing diagnosis. ALVD was observed in 53 participants (systolic 11, diastolic 42) (13%; 95%CI: 9–16%). HF risk factor prevalence was: hypertension 42% (95%CI: 37–46%), diabetes 34% (95%CI: 30–39%), coronary artery disease (CAD) 7% (95%CI: 5–10%), obesity (BMI ≥ 30 kg/m2 ) 42% (95%CI: 38–47%), and rheumatic heart disease or previous acute rheumatic fever 7% (95%CI: 5–10%). In logistic regression (adjusted for age, gender), HF was associated with CAD (9.6, p < 0.0001), diabetes (OR 5.6, p = 0.001), hypertension (OR 5.0, p = 0.005), and obesity (OR 2.9, p = 0.02). In multivariate models (adjusted for age, sex, HF risk factors, BNP, creatinine) severity of systolic dysfunction was independently associated with male gender (p = 0.04) and BNP (p = 0.003) and diastolic dysfunction with age (p < 0.0001), diabetes (p = 0.008) and BNP (p = 0.005). Conclusion: HF (much undiagnosed), ALVD, and risk factors in this young population were high. BNP was independently associated with systolic and diastolic dysfunction. These findings may have implications for developing strategies to improve the poorer outcomes within Indigenous populations. http://dx.doi.org/10.1016/j.hlc.2012.05.746