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Re: Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander People
LETTER TO THE EDITOR
Heart, Lung and Circulation (2015) 24, 626 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2015.01.003
Re: Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander People The Editor The ESSENCE document describing Essential Services Standards for Aboriginal and Torres Strait Islander people [1] is a well written and robust set of guidelines that could be more generally applicable in Australian communities, especially for non-Indigenous disadvantaged groups including migrants. Hypertension is included as one of the seven tables in the ESSENCE document. Although this is justified by a recent report stating that hypertension is the most common selfreported cardiovascular condition in the Aboriginal and Torres Strait Islander population [2], the prevalence is only 7% compared with much higher rates of diabetes in most Indigenous communities [3]. Our own comparative studies, which have included urban-dwelling Aboriginals with type 2 diabetes followed longitudinally since 1993 [4], suggest that hypertension is less common than in the majority Anglo-Celt group. By contrast, diabetes control is relatively poor amongst the Aboriginal patients who also have high rates of smoking. Given that the risk of diabetes is substantially increased in the Australian Indigenous population and a strong contributor to cardiovascular disease (albeit with a different, more chronic, time-line compared with other modifiable risk factors such as hypertension and dyslipidaemia) [5], we wonder why diabetes did not merit its own tabulated set of standards in the document. We would hope that the current format of the recommendations is not interpreted as meaning that hypertension is of greater importance than diabetes in the management of cardiovascular risk in Indigenous patients.
Timothy M.E. Davisa Wendy A. Davisa Daniel McAullayb a University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Australia b Edith Cowan University, Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Mt Lawley, Western Australia, Australia and Australian National University, Australian Primary Health Care Research Institute, Canberra, Australian Capital Territory, Australia Received 16 December 2014; accepted 8 January 2015; online published-ahead-of-print 22 January 2015
References [1] Brown A, O’Shea RL, Mott K, McBride KF, Lawson T, Jennings GL, On behalf of the Essential Service Standards for Equitable National Cardiovascular Care for A, Torres Strait Islander people Steering Committee. Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander People. Heart Lung Circ 2015;24(2):126–41. [2] Penm E. Cardiovascular disease and its associated risk factors in Aboriginal and Torres Strait Islander peoples, 2004-05. Canberra: AIHW; 2008. [3] Minges KE, Zimmet P, Magliano DJ, Dunstan DW, Brown A, Shaw JE. Diabetes prevalence and determinants in Indigenous Australian populations: A systematic review. Diabetes Res Clin Pract 2011;93:139–49. [4] Davis TM, Hunt K, McAullay D, Chubb SA, Sillars BA, Bruce DG, et al. Continuing disparities in cardiovascular risk factors and complications between aboriginal and Anglo-Celt Australians with type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 2012;35:2005–11. [5] Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577–89.
DOI of original article: http://dx.doi.org/10.1016/j.hlc.2014.09.021
© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Heart, Lung and Circulation (2015) 24, 626 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2015.01.003
Re: Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander People The Editor The ESSENCE document describing Essential Services Standards for Aboriginal and Torres Strait Islander people [1] is a well written and robust set of guidelines that could be more generally applicable in Australian communities, especially for non-Indigenous disadvantaged groups including migrants. Hypertension is included as one of the seven tables in the ESSENCE document. Although this is justified by a recent report stating that hypertension is the most common selfreported cardiovascular condition in the Aboriginal and Torres Strait Islander population [2], the prevalence is only 7% compared with much higher rates of diabetes in most Indigenous communities [3]. Our own comparative studies, which have included urban-dwelling Aboriginals with type 2 diabetes followed longitudinally since 1993 [4], suggest that hypertension is less common than in the majority Anglo-Celt group. By contrast, diabetes control is relatively poor amongst the Aboriginal patients who also have high rates of smoking. Given that the risk of diabetes is substantially increased in the Australian Indigenous population and a strong contributor to cardiovascular disease (albeit with a different, more chronic, time-line compared with other modifiable risk factors such as hypertension and dyslipidaemia) [5], we wonder why diabetes did not merit its own tabulated set of standards in the document. We would hope that the current format of the recommendations is not interpreted as meaning that hypertension is of greater importance than diabetes in the management of cardiovascular risk in Indigenous patients.
Timothy M.E. Davisa Wendy A. Davisa Daniel McAullayb a University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Australia b Edith Cowan University, Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Mt Lawley, Western Australia, Australia and Australian National University, Australian Primary Health Care Research Institute, Canberra, Australian Capital Territory, Australia Received 16 December 2014; accepted 8 January 2015; online published-ahead-of-print 22 January 2015
References [1] Brown A, O’Shea RL, Mott K, McBride KF, Lawson T, Jennings GL, On behalf of the Essential Service Standards for Equitable National Cardiovascular Care for A, Torres Strait Islander people Steering Committee. Essential Service Standards for Equitable National Cardiovascular Care for Aboriginal and Torres Strait Islander People. Heart Lung Circ 2015;24(2):126–41. [2] Penm E. Cardiovascular disease and its associated risk factors in Aboriginal and Torres Strait Islander peoples, 2004-05. Canberra: AIHW; 2008. [3] Minges KE, Zimmet P, Magliano DJ, Dunstan DW, Brown A, Shaw JE. Diabetes prevalence and determinants in Indigenous Australian populations: A systematic review. Diabetes Res Clin Pract 2011;93:139–49. [4] Davis TM, Hunt K, McAullay D, Chubb SA, Sillars BA, Bruce DG, et al. Continuing disparities in cardiovascular risk factors and complications between aboriginal and Anglo-Celt Australians with type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 2012;35:2005–11. [5] Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577–89.
DOI of original article: http://dx.doi.org/10.1016/j.hlc.2014.09.021
© 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.