688 A Comparison of Clinical Characteristics and Outcomes Between Indigenous and Non-Indigenous Patients Presenting to Townsville Hospital Emergency Department With Chest Pain

Abstract

Literature regarding clinical characteristics of Indigenous Australians (IA) presenting to the Emergency Departments (ED) with chest pain (CP) is lacking. They have a high rate of ischemic heart disease (IHD), accounting for 11% of all deaths in that population. A retrospective single-centre audit. Charts were reviewed for both Indigenous and non-Indigenous patients 18 years and older who presented to the Townsville Hospital (TTH) ED with CP from January to December 2017. The aim of the study is to compare the cardiovascular risk factors, social characteristics, and the clinical outcomes between them. 4087 patients presented to TTH ED with CP suggestive of angina. IA were over-represented making up 19% of the total cohort. They presented to the hospital and suffered from Acute Coronary Syndrome (ACS) at much younger age [Median age: 45 vs 52, p<0.005 and 51 vs 64, p <0.005, respectively]. Traditional cardiovascular risks were significantly higher and the incidence of alcohol excess and discharge against medical advice was higher among IA [25% vs 7 and 6.5% vs 2.7% respectively]. The proportions of Indigenous patients with the diagnosis of ACS, CP for investigations and cardiac CP were significantly higher by the Major Adverse Cardiac Events (MACE) at one year [MACE: 15.9% vs 8.8%; p=0.003]. Indigenous Australians had higher cardiovascular risk factors, social disadvantage and worse clinical outcomes compared to non-Indigenous Australians. Parity in outcomes between Indigenous and non-Indigenous Australians will need restructuring of their care in the emergency departments to meet their unique needs.