National Report Card on Hospital care for heart disease in Indigenous Australia Traven Lea, National Manager, Aboriginal and Torres Strait Islander Program Friday, 3 rd May 2007

Aboriginal and Torres Strait Islander people with coronary heart disease: Further perspectives on health status and treatment Australian Institute of Health and Welfare Report:

AIHW Investigation What is not known 1.more likely to have a heart attack in the first place; 2.much lower survival rates; 3.complex cases; 4.diagnosis and treatment patterns; or 5.a combination of these and other factors.

Purpose & Structure of Report Four key areas: incidence of major coronary events case fatality from major coronary events use of coronary procedures in hospital case complexity in hospital.

Methodology Data Source Australian Institute of Health and Welfare AIHW National Mortality Database AIHW National Hospital Morbidity Database

Data Quality Incomplete and variable Indigenous identification in births, deaths and hospital records. The extent to which Indigenous people self-identify. Qld, WA, SA & NT.

Health Measures Incidence of major coronary events Case fatality Coronary procedures Case complexity

Health Measures cont. Incidence of major coronary events  admission to hospital for acute myocardial infarction (AMI)  death from CHD

Health Measures cont. Case fatality proportion of cases that are fatal within a specific time period includes deaths that occurred both in and out of hospital

Health Measures cont. Coronary procedures coronary angiography percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)

Health Measures cont. Case complexity Co-morbidities include: diabetes, hypertensive diseases high cholesterol, heart failure, chronic kidney failure, chronic obstructive pulmonary disease and chronic rheumatic heart disease or other valve disorders, and cerebrovascular diseases

Incidence of major coronary events

Case Fatality

Coronary Procedures

Case Complexity (co-morbidities) Note: Co-morbidities studied include diabetes, hypertensive diseases, high cholesterol, heart failure, chronic renal failure, chronic obstructive pulmonary disease, chronic rheumatic heart disease or other valve disorders, and cerebrovascular disease. Source: AIHW National Hospital Morbidity Database. Figure 6: Number of selected co-morbidities for CHD hospitalisations, 2002–2003

AIHW Report The findings indicate that compared to other Australians, Indigenous Australians had: 3 times the rate of major coronary events such as heart attack and 1.4 times the out-of-hospital death rate from CHD

AIHW Report And when in hospital: More than twice the in-hospital CHD death rate; A 40% lower rate of being investigated by angiography; A 40% lower rate of coronary angioplasty or stents procedures; A 20% lower rate of coronary bypass surgery.

Implications Personnel – Family Sector

Heartline: