Philip A Tideman1, Rosy Tirimacco2, David P Senior3, John J Setchell4, Luan T Huynh5, Rosanna Tavella6, Philip E G Aylward7, Derek P B Chew7. 1. Country Health, Adelaide, SA, Australia. Derek.Chew@flinders.edu.au. 2. Country Health, Adelaide, SA, Australia. 3. Rural Doctors Workforce Agency, Adelaide, SA, Australia. 4. Royal Flying Doctor Service, Adelaide, SA, Australia. 5. Cardiology, Lyell McEwin and Modbury Hospitals, Adelaide, SA, Australia. 6. SA Health, Adelaide, SA, Australia. 7. Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, SA, Australia.
Abstract
OBJECTIVE: To evaluate the impact of the regionalised Integrated Cardiovascular Clinical Network (ICCNet) on 30-day mortality among patients with myocardial infarction (MI) in an Australian rural setting. DESIGN, SETTING AND PATIENTS: An integrated cardiac support network incorporating standardised risk stratification, point-of-care troponin testing and cardiologist-supported decision making was progressively implemented in non-metropolitan areas of South Australia from 2001 to 2008. Hospital administrative data and statewide death records from 1 July 2001 to 30 June 2010 were used to evaluate outcomes for patients diagnosed with MI in rural and metropolitan hospitals. MAIN OUTCOME MEASURE: Risk-adjusted 30-day mortality. RESULTS: 29 623 independent contiguous episodes of MI were identified. The mean predicted 30-day mortality was lower among rural patients compared with metropolitan patients, while actual mortality rates were higher (30-day mortality: rural, 705/5630 [12.52%] v metropolitan, 2140/23 993 [8.92%]; adjusted odds ratio [OR], 1.46; 95% CI, 1.33-1.60; P< 0.001). After adjustment for temporal improvement in MI outcome, availability of immediate cardiac support was associated with a 22% relative odds reduction in 30-day mortality (OR, 0.78; 95% CI, 0.65-0.93; P= 0.007). A strong association between network support and transfer of patients to metropolitan hospitals was observed (before ICCNet, 1102/2419 [45.56%] v after ICCNet, 2100/3211 [65.4%]; P< 0.001), with lower mortality observed among transferred patients. CONCLUSION: Cardiologist-supported remote risk stratification, management and facilitated access to tertiary hospital-based early invasive management are associated with an improvement in 30-day mortality for patients who initially present to rural hospitals and are diagnosed with MI. These interventions closed the gap in mortality between rural and metropolitan patients in South Australia.
OBJECTIVE: To evaluate the impact of the regionalised Integrated Cardiovascular Clinical Network (ICCNet) on 30-day mortality among patients with myocardial infarction (MI) in an Australian rural setting. DESIGN, SETTING AND PATIENTS: An integrated cardiac support network incorporating standardised risk stratification, point-of-care troponin testing and cardiologist-supported decision making was progressively implemented in non-metropolitan areas of South Australia from 2001 to 2008. Hospital administrative data and statewide death records from 1 July 2001 to 30 June 2010 were used to evaluate outcomes for patients diagnosed with MI in rural and metropolitan hospitals. MAIN OUTCOME MEASURE: Risk-adjusted 30-day mortality. RESULTS: 29 623 independent contiguous episodes of MI were identified. The mean predicted 30-day mortality was lower among rural patients compared with metropolitan patients, while actual mortality rates were higher (30-day mortality: rural, 705/5630 [12.52%] v metropolitan, 2140/23 993 [8.92%]; adjusted odds ratio [OR], 1.46; 95% CI, 1.33-1.60; P< 0.001). After adjustment for temporal improvement in MI outcome, availability of immediate cardiac support was associated with a 22% relative odds reduction in 30-day mortality (OR, 0.78; 95% CI, 0.65-0.93; P= 0.007). A strong association between network support and transfer of patients to metropolitan hospitals was observed (before ICCNet, 1102/2419 [45.56%] v after ICCNet, 2100/3211 [65.4%]; P< 0.001), with lower mortality observed among transferred patients. CONCLUSION: Cardiologist-supported remote risk stratification, management and facilitated access to tertiary hospital-based early invasive management are associated with an improvement in 30-day mortality for patients who initially present to rural hospitals and are diagnosed with MI. These interventions closed the gap in mortality between rural and metropolitan patients in South Australia.
Authors: Craig M Lilly; Emily Ensom; Sean Teebagy; Danielle DiMezza; Denise Dunlap; Nathaniel Hafer; Bryan Buchholz; David McManus Journal: Point Care Date: 2020-12
Authors: Ingo Ahrens; Oleg Averkov; Eduardo C Zúñiga; Alan Y Y Fong; Khalid F Alhabib; Sigrun Halvorsen; Muhamad A B S K Abdul Kader; Ricardo Sanz-Ruiz; Robert Welsh; Hongbin Yan; Philip Aylward Journal: Clin Cardiol Date: 2019-07-17 Impact factor: 2.882
Authors: Bernadette Bea Brown; Cyra Patel; Elizabeth McInnes; Nicholas Mays; Jane Young; Mary Haines Journal: BMC Health Serv Res Date: 2016-08-08 Impact factor: 2.655
Authors: Ruth H Arnold; Philip A Tideman; Gerard P Devlin; Gerard E Carroll; Alex Elder; Harry Lowe; Peter S Macdonald; Paul G Bannon; Craig Juergens; Mark McGuire; Justin A Mariani; Sean Coffey; Steven Faddy; Alex Brown; Sally Inglis; William Y S Wang Journal: Heart Lung Circ Date: 2020-05-07 Impact factor: 2.975