1. Aboriginal and Torres Strait Islander Health Branch
Queensland Cardiovascular Disease Burden in the Aboriginal and Torres Strait Islander Population
Aboriginal and Torres Strait Islander Health Branch

2. Overview Indigenous CVD Burden in Queensland Rheumatic Heart Disease
Aboriginal and Torres Strait Islander Better Cardiac Care Data Linkage Project

3. Burden of disease and injury
[This slide shows the breakdown of total burden of disease (both fatal and non-fatal) in Queensland’s Aboriginal and Torres Strait Islander people by the cause of burden.]
Our study found that in 2011, 68 per cent of the Indigenous burden was caused by the six leading broad cause groups.
Mental disorders were the leading contributor at 20 per cent (which was made up mainly of non-fatal burden), followed by cardiovascular disease at 14 per cent, diabetes, cancer, chronic respiratory disease and then unintentional injuries.
These are key areas to focus to improve the health and wellbeing of Queensland’s Aboriginal and Torres Strait Islander people.
The majority of burden from cardiovascular disease is ischaemic heart disease; cardiovascular disease occurs earlier compared to non-Indigenous populations; the Indigenous burden of cardiovascular disease is 3.7 times expected (if rates were equal to non-Indigenous population)

4. Burden of disease and injury gap
Explain what is meant by GAP
This slide demonstrates the burden of health gap between Aboriginal and Torres Strait Islander Queenslanders and non-Indigenous Queenslanders
Looking more closely at the broad causes contributing to the gap:
Chronic disease, mental disorders and intentional injuries were significant contributors to the gap in disease and injury burden.
These represent priority areas for improving the gap in burden of disease between Aboriginal and Torres Strait Islander and non-Indigenous Queenslanders.
- Cardiovascular disease accounts for 20% of the burden of health gap between the two groups
52 per cent of gap

5. Queensland CVD Burden by age & Indigenous status (2011)
Indigenous CVD burden occurs at a younger age (40-64) compared to the non-Indigenous group (70+)

6. Indigenous CVD in QLD Compared to non-Indigenous Queenslanders the:
CVD mortality rate was around 25% higher for Aboriginal and Torres Strait Islander Queenslanders in 2011
CVD separation rate was 73% higher for Aboriginal and Torres Strait Islander Queenslanders in 2013–14
The rate of CVD burden of disease 2.5 times higher for Aboriginal and Torres Strait Islander Queenslanders in 2011
The cost to the public inpatient hospital system from Aboriginal and Torres Strait Islander cardiac related SRGs for was $56.4 million higher than it should have been – Indigenous rates equal that of non-Indigenous rates

7. Queensland CVD Burden by condition, age & Indigenous status (2011)
Non-Indigenous
Of the CVD and these six conditions
Ischaemic heart disease starts earlier in Indigenous Queenslanders
Stroke starts earlier in non-Indigenous Queenslanders
Rheumatic heart disease in younger Indigenous Queenslanders and barely visible in the non-Indigenous population

8. Queensland CVD Burden Indigenous population (2011)
Second highest contribution to the burden of disease in the Indigenous Queensland population.
Just less than 10% of total burden is fatal cardiovascular disease.

9. Mortality – cardiovascular
Age standardised Aboriginal and Torres Strait Islander cardiovascular disease mortality rate, Queensland 2002 to 2015

10. Mortality – cardiovascular

11. Mortality – cardiovascular

12. Access to Procedures for ACS Hospitalisations

13. Rheumatic Heart Disease

14. Better Cardiac Care Data Linkage - Aims
Identify gaps in the health care continuum for Indigenous people with cardiovascular disease (2010/11 to 2015/16)
Ischaemic heart disease
Chronic heart failure
Stroke
Acute rheumatic fever / Rheumatic heart disease
Examine ARF/RHD trends from 2000 to 2016
identify targets, timelines, recommendations about optimal primary, secondary & tertiary based interventions to end RHD in Qld

15. Better Cardiac Care Data Linkage Research Project
Identify patients first hospitalised with disease
describe access to primary, secondary, acute, post-acute care
delays & disruptions in continuum of care based on best-practice standards
variation in care (location & population groups)
impact of variation in care on patient outcomes & system costs
EDIS
AusLAB
NDI
MBS
iPharmacy
PBS
PaWs
QHAPDC
RHD Register

16. Data Linkage – ARF / RHD (2000-2016)
Identify patients hospitalised/notified with disease
describe incidence, prevalence, disease progression & outcomes
collaboration with End-RHD Centre for Research Excellence (Telethon Kids Institute)
NDI
QHAPDC
RHD Register

17. Outcomes
picture of individual patient experience through health system layers
understanding of gaps, service needs
at state & HHS level
at primary, secondary, tertiary levels & their intersects
in-depth understanding of ARF/RHD burden overtime
develop baseline, targets, interventions to end RHD in Qld
CVD onset earlier for Indigenous population

18. Better Cardiac Care

19. Guidelines Guidelines NHMRC Health Advisory Committee September 2005
A guide for health professionals
Strengthening cardiac rehabilitation and secondary prevention for Aboriginal and Torres Strait Islander people
Review of guidelines

20. New Accreditation Standards

22. Health care is a humanitarian right but the reality is that economic cost will always be part of the equation
Health professionals often have to straddle and reconcile the divide that can exist

23. Paradigm Shift
If we are serious about health being a human right and accessible to all, an important paradigm shift needs to occur
We need to base our interactions on kindness compassion and respect
Kindness for all, especially those where it has not been of abundance in that persons life
Compassion for the adversity patients face
Respect for patients lived experience

24. Cultural Competency

25. Identification Processes
Ask the question
Are you of Aboriginal or Torres Strait Islander Origin?
(AIHW) National best practice guidelines for collecting Indigenous status in health data sets.

26. Hospital Data What is kept is there a report that is generated
What is captured in the report
Drill down into the detail
How is it coded

27. Environment Welcoming Health Workers
Referral pathways and Partnerships
Flexible delivery
Health literacy
Resources
Connection to primary health care

28. National Heart Foundation Lighthouse
18 sites Nationally
Improving health outcomes for Aboriginal and Torres Strait Islander people with acute coronary syndrome
Domains
Governance
Cultural competence
Workforce
Care pathways

29. Discharge Against Medical Advice DAMA
Cardiac Strategy 1.1% Target
Best case scenario…. Prevent this from occurring
If we can’t prevent DAMA then we need a clear process of review and plan

30. DAMA not the problem symptom of the system
What you can influence
What you can’t Influence

31. Most important What is the outcome?
What happens to the them when they leave?

32. Discharge Against Medical Advice DAMA
Prevent DAMA
Unable to prevent Patient stays in Hospital
Review medical
record & case
review with specialist
Early contact with patient
(within 3 days)
Communicate plan with
GP, specialist & patient
Case manage to ensure
appropriate follow up.

33. Discharge Against Medical Advice DAMA
Since implementation of flow chart process there have been 19 cases of DAMA (417 episodes of care) = DAMA rate 4.55%
16 (84%)patients, prompt follow up with their GP and or specialist was arranged
3 (15%) cases lost to follow up
5 (26%) patients managed back into the acute care setting and received evidence based care
Pacemaker=1
coronary artery bypass surgery=2
coronary angioplasty=2
Early contact, clinical care review and case management post DAMA supports patient in accessing appropriate medical follow up and aids in evidence based care
Good linkage and communication improves continuity of care

34. Questions