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Cardiac Surgery in Indigenous Australians, a Cardiologists Perspective
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Abstracts
Cardiac surgery in Indigenous Australians poses many challenges, particularly to the Indigenous patients who live in more remote communities where access to specialist physicians, surgeons and Echocardiography is problematic. Other problems encountered are late presentation, associated co-morbidities and difficulties with medication adherence, especially anticoagulation. Indigenous patients have a significantly higher prevalence of diabetes, chronic kidney disease, hypertension and smoking. Long term studies have shown significantly worse outcome for Indigenous patients following valve or coronary bypass surgery. There is an increased need for valve sparing surgery to avoid the need for anticoagulation. Surgeons need to be better acquainted with the local circumstances of each patient in planning surgery. There may be a case for selected referral centres for rheumatic heart disease surgery in Indigenous patients in order to increase case volume and expertise of individual surgeons.
Discussion: Royal Darwin Hospital is the only major hospital with onsite cardiac services in the Northern Territory. RDH has most cardiac diagnostic capabilities but does not have any onsite interventional or cardiac surgical facilities. RDH cardiology unit has established a long standing relationship with Flinders Medical Centre (Cardiology and Cardio-thoracic units). FMC provides the vast majority of the cardiac surgical support to patients from the Top End. In the past, many complex patients have been managed in an ad-hoc manner and some have been lost to follow up resulting in poor outcome. Over the last two years, there have been improvements with establishment of Indigenous cardiac nurse co-ordinator (ICNC) positions and weekly complex case conferencing ("Triple C’’) with FMC. A weekly case conferencing session is dedicated between these two units to discuss complex patients with rheumatic heart disease. There is an open and transparent discussion among a variety of clinicians (both interventional cardiologists and cardiac surgeons). Discussions and consensus recommendations are documented and communicated through the "chair’’ to all the clinicians involved. Recommendations are followed through by the ICNC based at RDH. ICNC is involved in the communication with patients, primary care team, local cardiologists and FMC staff and ensure the patients are not lost in the system. There will also be an establishment of a NT Cardiovascular Information System (CVIS) which is a partnership between NT Cardiac Pty Ltd, NT Government and the Commonwealth). Conclusions: Despite the significant challenges faced by the remote Indigenous patients with RHD, there is an opportunity to improve clinical outcome by a co-ordinated and collaborative approach by all the service providers and the health systems involved.
http://dx.doi.org/10.1016/j.hlc.2013.10.017
http://dx.doi.org/10.1016/j.hlc.2013.10.018
Saturday 24 August – 5.3/1405–1420
Saturday 24 August – 5.4/1420–1435
Role of Care Co-ordination and Case Conferencing in Managing Pre and Post Operative Challenges in the NT Remote Indigenous Patients with Severe Rheumatic Heart Disease
Midterm Results of Coronary Artery Bypass Grafting in an Australian Indigenous Population
mortality data were more favourable in patients undergoing MIMS than in historical controls. http://dx.doi.org/10.1016/j.hlc.2013.10.016 INDIGENOUS CARDIAC HEALTH – Abstracts 5.2 to 5.7 Saturday 24 August – 5.2/1350–1405 Cardiac Surgery in Indigenous Australians, a Cardiologists Perspective Warren F. Walsh The Prince of Wales Hospital, Randwick, Sydney, Australia
Dr Nadarajah Kangaharan *, Dr Marcus Ilton, Dr Colin Farquharson, Dr Pupalan Iyngkaran, Dr Mary Wicks Department of Cardiology, Royal Darwin Hospital, Northern Territory, Australia * Corresponding author. Background: The Northern Territory has a high proportion of Indigenous patients living remotely with high burden of rheumatic heart disease (RHD). There are significant management challenges faced by the local cardiac service in providing optimum and evidence based therapy. Some of these challenges include both patient factors (young age, pregnancy, non-adherence to therapy, psychosocial factors) and system issues (lack of co-ordination, infrastructure and staffing issues). Objective: We aim to discuss some of these recent challenging cases of RHD and discuss our co-ordinated and collaborative approach to improve patient care and the outcome.
Paul Wiemers 1,2*, Lucy Marney 1, Nicole White 3, Bough 1, Alistair Hustig 1, Wei Tan 1, Ching-Siang Cheng 1, Dong Kang 1, Sumit Yadav 1, John Fraser 2,4, Robert Tam 1 1
The Townsville Hospital, Townsville, Australia University of Queensland School of Medicine, Brisbane, Australia 3 Mathematical Sciences School, Queensland University of Technology, Brisbane, Australia 4 Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia * Corresponding author. 2
Introduction: Indigenous Australians experience poorer health outcomes and reduced life expectancy compared with non-Indigenous Australians. Ischaemic heart disease is a major contributor to this mortality gap. Limited evidence exists in regard to the outcomes of coronary revascularisation in the Australian Indigenous population. Only surgical series have been reported with longer term comparative follow-up restricted to survival analyses. We aimed to investigate the
Abstracts
Cardiac surgery in Indigenous Australians poses many challenges, particularly to the Indigenous patients who live in more remote communities where access to specialist physicians, surgeons and Echocardiography is problematic. Other problems encountered are late presentation, associated co-morbidities and difficulties with medication adherence, especially anticoagulation. Indigenous patients have a significantly higher prevalence of diabetes, chronic kidney disease, hypertension and smoking. Long term studies have shown significantly worse outcome for Indigenous patients following valve or coronary bypass surgery. There is an increased need for valve sparing surgery to avoid the need for anticoagulation. Surgeons need to be better acquainted with the local circumstances of each patient in planning surgery. There may be a case for selected referral centres for rheumatic heart disease surgery in Indigenous patients in order to increase case volume and expertise of individual surgeons.
Discussion: Royal Darwin Hospital is the only major hospital with onsite cardiac services in the Northern Territory. RDH has most cardiac diagnostic capabilities but does not have any onsite interventional or cardiac surgical facilities. RDH cardiology unit has established a long standing relationship with Flinders Medical Centre (Cardiology and Cardio-thoracic units). FMC provides the vast majority of the cardiac surgical support to patients from the Top End. In the past, many complex patients have been managed in an ad-hoc manner and some have been lost to follow up resulting in poor outcome. Over the last two years, there have been improvements with establishment of Indigenous cardiac nurse co-ordinator (ICNC) positions and weekly complex case conferencing ("Triple C’’) with FMC. A weekly case conferencing session is dedicated between these two units to discuss complex patients with rheumatic heart disease. There is an open and transparent discussion among a variety of clinicians (both interventional cardiologists and cardiac surgeons). Discussions and consensus recommendations are documented and communicated through the "chair’’ to all the clinicians involved. Recommendations are followed through by the ICNC based at RDH. ICNC is involved in the communication with patients, primary care team, local cardiologists and FMC staff and ensure the patients are not lost in the system. There will also be an establishment of a NT Cardiovascular Information System (CVIS) which is a partnership between NT Cardiac Pty Ltd, NT Government and the Commonwealth). Conclusions: Despite the significant challenges faced by the remote Indigenous patients with RHD, there is an opportunity to improve clinical outcome by a co-ordinated and collaborative approach by all the service providers and the health systems involved.
http://dx.doi.org/10.1016/j.hlc.2013.10.017
http://dx.doi.org/10.1016/j.hlc.2013.10.018
Saturday 24 August – 5.3/1405–1420
Saturday 24 August – 5.4/1420–1435
Role of Care Co-ordination and Case Conferencing in Managing Pre and Post Operative Challenges in the NT Remote Indigenous Patients with Severe Rheumatic Heart Disease
Midterm Results of Coronary Artery Bypass Grafting in an Australian Indigenous Population
mortality data were more favourable in patients undergoing MIMS than in historical controls. http://dx.doi.org/10.1016/j.hlc.2013.10.016 INDIGENOUS CARDIAC HEALTH – Abstracts 5.2 to 5.7 Saturday 24 August – 5.2/1350–1405 Cardiac Surgery in Indigenous Australians, a Cardiologists Perspective Warren F. Walsh The Prince of Wales Hospital, Randwick, Sydney, Australia
Dr Nadarajah Kangaharan *, Dr Marcus Ilton, Dr Colin Farquharson, Dr Pupalan Iyngkaran, Dr Mary Wicks Department of Cardiology, Royal Darwin Hospital, Northern Territory, Australia * Corresponding author. Background: The Northern Territory has a high proportion of Indigenous patients living remotely with high burden of rheumatic heart disease (RHD). There are significant management challenges faced by the local cardiac service in providing optimum and evidence based therapy. Some of these challenges include both patient factors (young age, pregnancy, non-adherence to therapy, psychosocial factors) and system issues (lack of co-ordination, infrastructure and staffing issues). Objective: We aim to discuss some of these recent challenging cases of RHD and discuss our co-ordinated and collaborative approach to improve patient care and the outcome.
Paul Wiemers 1,2*, Lucy Marney 1, Nicole White 3, Bough 1, Alistair Hustig 1, Wei Tan 1, Ching-Siang Cheng 1, Dong Kang 1, Sumit Yadav 1, John Fraser 2,4, Robert Tam 1 1
The Townsville Hospital, Townsville, Australia University of Queensland School of Medicine, Brisbane, Australia 3 Mathematical Sciences School, Queensland University of Technology, Brisbane, Australia 4 Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia * Corresponding author. 2
Introduction: Indigenous Australians experience poorer health outcomes and reduced life expectancy compared with non-Indigenous Australians. Ischaemic heart disease is a major contributor to this mortality gap. Limited evidence exists in regard to the outcomes of coronary revascularisation in the Australian Indigenous population. Only surgical series have been reported with longer term comparative follow-up restricted to survival analyses. We aimed to investigate the