A recent study, published in the Medical Journal of Australia, has identified that Aboriginal patients in South Australia presenting with an ACS were significantly less likely than non-Aboriginal patients to undergo angiography, after age, comorbidities and remoteness were controlled for.
Deaths related to coronary heart disease amongst Aboriginal Australians is twice that of non-Aboriginal Australians, and is a major contributor to the 10-year life expectancy gap between Aboriginal and non-Aboriginal Australians. Acute myocardial infarction (AMI) is particularly high among Aboriginal Australians. Despite this, the Australian Institute of Health and Welfare identified major disparities in the management of Aboriginal and Torres Strait Islander patients hospitalised with ACS between 2002 and 2003, including a 40% lower rate of coronary angiography, a 40% lower rate of percutaneous coronary intervention (PCI), and a 20% lower rate of coronary artery bypass graft surgery (CABG).
The authors reported that reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non-cardiac (16%), non-invasive test performed (8%), and discharge against medical advice (11%). However, for over a third (36%) of Aboriginal patients the reasons for not undergoing angiography were unclear.
Aboriginal patients more likely to undergo angiography were those who received care facilitated by an Aboriginal liaison officer or arrived at the hospital with an escort. Those that had a negative hospital experience, health provider bias favouring conservative managemebt based on complex comorbidities or presumed adherence to medications, and patient choice were implicated in the difference in angiography rate.
The authors noted that the findings raises concerns about barriers to quality care for Aboriginal people, including poor engagement and communication, a lack of coordinated care, and inadequate cultural competence of health care providers, factors which can result in isolation, fear and disengagement patients.