Metro, remote heart outcomes on same beat

HISTORIC health data once found discharged heart attack patients faced poor clinical outcomes living in remote regional or rural areas.

But new research by a Grampians Health cardiology professional is showing that those stats are changing.

“In 2009 to 2012, a study showed that remoteness was a driving force for all-cause cardiovascular death in Australians, which was done after adjusting for socioeconomic status, which is a really important consideration,” said Grampians Health cardiology pharmacist and researcher Adam Livori.

“We know that socioeconomic status typically decreases as remoteness increases, in other words, we have more affluent areas in more metropolitan parts of the country.

“The first question of my PhD was, should the view from your window determine outcomes following an admission for myocardial infarction?”

As part of the Monash University Centre for Medicine Use and Safety, Mr Livori aimed to quantify post-heart attack clinical outcomes between Victoria’s metro and remote areas and looked all the state’s myocardial infarction admissions in the five years between 2012 and 2017.

He said he tried different statistical techniques to estimate outcomes along a remoteness and service accessibility scale.

“We know since 2012, when the dataset from our study began, access to catheter laboratory services for myocardial infarctions has increased,” Mr Livori said.

“That’s the year the laboratory opened in Ballarat, and following that in 2014, we had the first quality registry for post coronary stenting, the Victorian Cardiac Outcomes Registry.

“The question posed was, does this disparity between remoteness and clinical outcomes following a heart attack still exist?

“What the data showed us is that regardless of where you might live in terms of remoteness, the predicted incidence rate following a heart attack of you having these major adverse cardiovascular events is actually the same.

“There is no difference with regards to remoteness.”

Mr Livori said the likelihood of a person dying of a heart attack was the same in the centre of Ballarat, Melbourne, or in remote western Victoria, but financial investment in regional cardiology care has been key to this result.

“Individuals who are working within our health services across Victoria, and the initiatives being implemented at a system level are working, because disparities previously reported no longer exist,” he said.

“Does this mean we’ve fixed the problem? No, but it means we’ve addressed one of the many inequities that can exist within our health system.”

A heart attack is when a person experiences sudden coronary thrombosis, where cardiac arrest is when the heart stops functioning, and this can be permanent or temporary.

“Cardiovascular disease is the number one cause of death world-wide,” Mr Livori said.

“It’s a major source of health and economic burden. My colleagues did some forecasting studies and have predicted it could cost Australia over $61.89 billion between 2020 and 2029.”

The International Journal of Cardiology plans to publish Mr Livori’s research.