Abstract 142: Disparities in the Management of Acute Coronary Syndrome in Australian Aboriginal Patients

Abstract

Introduction: It is well recognised that Aboriginal Australians have poorer cardiovascular outcomes compared to non-Aboriginal Australians. Evaluation of contemporary management practices may provide insights into potential service improvements that could promote better outcomes. Objectives: To compare the clinical features and hospital management of Aboriginal and non-Aboriginal Australian patients undergoing coronary angiography in public hospitals in South Australia (SA) following acute coronary syndrome (ACS). Methods: The Coronary Angiogram Database of South Australia (CADOSA) is a comprehensive registry of all public cardiac catheterization procedures performed in SA. Data for procedures undertaken in 2012 following an ACS, were used to detail the management of these patients. Comparisons between Aboriginal and Torres Strait Islander patients with non-Aboriginal patients were age adjusted where appropriate. Results: In 2012, 3,014 coronary angiogram procedures were undertaken for ACS presentation and of these, 144 (5%) were undertaken on Aboriginal and Torres Strait Islander patients. Compared to non-Aboriginal ACS patients, these patients were significantly younger (50±11 vs 64±13 years, p<0.01) and more likely to be female (38% vs 30%, OR=2 (1.4-2.9) p<0.05). Despite their younger age, Aboriginal and Torres Strait Islander patients were more likely to present with acute myocardial infarction (AMI) (72% vs 60%, OR=1.6 (1.1-2.4), p=0.012), however they were less likely to undergo percutaneous coronary intervention (PCI) (34% vs 43%, OR=0.6 (0.4-0.8) p<0.01). CABG was observed in 13% of Aboriginal and Torres Strait Islander patients; similar to non-Aboriginal patients (10%, OR=1.4 (0.9-2.4) p=0.214). Discharge therapies are described in Table 1. Conclusion: Aboriginal ACS patients undergoing angiography are younger, more often female and more often present with AMI compared to non-Aboriginal ACS patients. Discharge medications are similar, however significantly less PCI procedures were undertaken in Aboriginal patients. Further investigation is required to evaluate the cause of this important disparity.