Abstract
Acute coronary syndromes (ACS) are life-threatening medical emergencies that require urgent treatment, posing particular challenges for systems of health care in regional and remote parts of the world characterised by large distances and widely dispersed populations and healthcare facilities. Northern Australia is such an environment. The prevalence of cardiovascular risk factors, coronary artery disease and ACS (myocardial infarction and unstable angina) in northern Australia is amongst the highest in Australia. Despite the high burden of disease, appropriate healthcare services to address these important health challenges have been inadequate. The Australian Commission on Safety and Quality in Health Care has released a Clinical Care Standard for Acute Coronary Syndromes and the National Heart Foundation of Australia has developed an ACS Capabilities Framework, which together define minimum standards of care regardless of the patient's location. Strategies such as uniform state-wide ACS clinical pathways provide guidance on how evidence-based care can be provided in a range of geographical settings and to all populations, including Indigenous Australians. The continuing evolution of cardiac catheter laboratories in Townsville, Cairns, Mackay and Darwin has facilitated improved treatment for ACS in northern Australia, and has supported the development of region-wide, integrated, multidisciplinary pathways of care. Systems of care in ACS require consideration of the perspectives of the patient (from symptom onset to long-term secondary prevention of further events), the health system ('dissolving' traditional regional silos of care to enable a higher critical mass, greater cooperation, better communication and improved efficiency) and healthcare disciplines and services (including ambulance, retrieval, local health centres and local hospitals, tertiary centres, cardiac rehabilitation and general practice).
Highlights
Acute coronary syndromes (ACS: myocardial infarction and unstable angina) are life-threatening medical emergencies that require urgent treatment to save lives and prevent permanent damage to the heart in survivors
Northern Australia is characterised by vast distances with a significantly dispersed population
The authors convened two conferences, in Townsville in March 2014 and Cairns in August 2015, to explore how effective, integrated, multidisciplinary care can be provided to patients with ACS throughout northern Australia, regardless of their location
Summary
Acute coronary syndromes (ACS: myocardial infarction and unstable angina) are life-threatening medical emergencies that require urgent treatment to save lives and prevent permanent damage to the heart in survivors. An integrated network of care to ensure guideline-based treatment and to minimise delay in providing definitive therapy is desirable[1], but considerable barriers exist to implementing such systems in regional and remote locations. The authors convened two conferences, in Townsville in March 2014 and Cairns in August 2015, to explore how effective, integrated, multidisciplinary care can be provided to patients with ACS throughout northern Australia, regardless of their location.
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