Hospital utilisation patterns for cardiovascular disease (CVD) 12 months post first-ever acute coronary syndrome (ACS) in Aboriginal and non-Aboriginal patients

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Abstract

ntroduction: Aboriginal Australians have additive risk for rehospitalisation following an ACS admission including: comorbid conditions, higher rates of complications and discharge against medical advice. We compared hospital utilisation patterns in Aboriginal and non-Aboriginal patients following a first-ever ACS admission (index). Methods: Person-linked hospital records from Western Australia were used to identify CVD admissions in the 12-month period following index ACS in 2007-2010 for patients aged 25-84 years. Outcomes were time to first CVD admission, number of CVD admissions and total length of stay (LOS), comparing Aboriginal to non-Aboriginal patients. We performed separate multivariable regression analyses for elective and emergency admissions accounting for deaths. Results: Aboriginal patients (5.7% of 16,942) were younger, more commonly women, had higher rates of comorbid conditions, and were less likely to receive coronary artery procedures (59.6% vs 70.3%) at index ACS than non-Aboriginal patients. Aboriginal patients waited longer for a booked admission (10th percentile:165days; 95% CI:86-267 versus 47days; 95% CI:43-52) but shorter for an emergency admission (20days; 95% CI:16-25 versus 39days 95% CI:35-44) than non-Aboriginal patients. In the 12 months post-index ACS, Aboriginal patients had 18% fewer elective admissions (p = 0.04) but 46% more emergency admissions (p < 0.001). They had similar LOS for elective admissions (p = 0.427) but 38% greater LOS for emergency admissions (p = 0.007). Conclusions: Following index ACS, Aboriginal patients had higher hospital utilisation for emergency admissions but fewer elective admissions compared to non-Aboriginal patients. More proactive early management and follow-up for Aboriginal patients is needed, including greater understanding of patient- and service-related factors that impede this occurring.
Original languageEnglish
Pages (from-to)S331
Number of pages1
JournalHeart Lung and Circulation
Volume26
Issue numberSupplement 2
DOIs
Publication statusPublished - 2017
EventCardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meeting - Perth Convention and Exhibition Centre, Perth, Australia
Duration: 10 Aug 201713 Aug 2017
Conference number: 65
http://www.csanz2017.com/

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Acute Coronary Syndrome
Cardiovascular Diseases
Emergencies
Length of Stay
Western Australia
Hospital Records
Coronary Vessels
Regression Analysis

Cite this

@article{4785f02275e44bcba637001d76c6d2ae,
title = "Hospital utilisation patterns for cardiovascular disease (CVD) 12 months post first-ever acute coronary syndrome (ACS) in Aboriginal and non-Aboriginal patients",
abstract = "ntroduction: Aboriginal Australians have additive risk for rehospitalisation following an ACS admission including: comorbid conditions, higher rates of complications and discharge against medical advice. We compared hospital utilisation patterns in Aboriginal and non-Aboriginal patients following a first-ever ACS admission (index). Methods: Person-linked hospital records from Western Australia were used to identify CVD admissions in the 12-month period following index ACS in 2007-2010 for patients aged 25-84 years. Outcomes were time to first CVD admission, number of CVD admissions and total length of stay (LOS), comparing Aboriginal to non-Aboriginal patients. We performed separate multivariable regression analyses for elective and emergency admissions accounting for deaths. Results: Aboriginal patients (5.7{\%} of 16,942) were younger, more commonly women, had higher rates of comorbid conditions, and were less likely to receive coronary artery procedures (59.6{\%} vs 70.3{\%}) at index ACS than non-Aboriginal patients. Aboriginal patients waited longer for a booked admission (10th percentile:165days; 95{\%} CI:86-267 versus 47days; 95{\%} CI:43-52) but shorter for an emergency admission (20days; 95{\%} CI:16-25 versus 39days 95{\%} CI:35-44) than non-Aboriginal patients. In the 12 months post-index ACS, Aboriginal patients had 18{\%} fewer elective admissions (p = 0.04) but 46{\%} more emergency admissions (p < 0.001). They had similar LOS for elective admissions (p = 0.427) but 38{\%} greater LOS for emergency admissions (p = 0.007). Conclusions: Following index ACS, Aboriginal patients had higher hospital utilisation for emergency admissions but fewer elective admissions compared to non-Aboriginal patients. More proactive early management and follow-up for Aboriginal patients is needed, including greater understanding of patient- and service-related factors that impede this occurring.",
author = "Derrick Lopez and Judith Katzenellenbogen and Francesco Sanfilippo and Matthew Knuiman and Michael Hobbs and Tom Briffa and Sandra Thompson",
year = "2017",
doi = "10.1016/j.hlc.2017.06.670",
language = "English",
volume = "26",
pages = "S331",
journal = "Heart, Lung & Circulation",
issn = "1444-2892",
publisher = "Academic Press",
number = "Supplement 2",

}

TY - JOUR

T1 - Hospital utilisation patterns for cardiovascular disease (CVD) 12 months post first-ever acute coronary syndrome (ACS) in Aboriginal and non-Aboriginal patients

AU - Lopez, Derrick

AU - Katzenellenbogen, Judith

AU - Sanfilippo, Francesco

AU - Knuiman, Matthew

AU - Hobbs, Michael

AU - Briffa, Tom

AU - Thompson, Sandra

PY - 2017

Y1 - 2017

N2 - ntroduction: Aboriginal Australians have additive risk for rehospitalisation following an ACS admission including: comorbid conditions, higher rates of complications and discharge against medical advice. We compared hospital utilisation patterns in Aboriginal and non-Aboriginal patients following a first-ever ACS admission (index). Methods: Person-linked hospital records from Western Australia were used to identify CVD admissions in the 12-month period following index ACS in 2007-2010 for patients aged 25-84 years. Outcomes were time to first CVD admission, number of CVD admissions and total length of stay (LOS), comparing Aboriginal to non-Aboriginal patients. We performed separate multivariable regression analyses for elective and emergency admissions accounting for deaths. Results: Aboriginal patients (5.7% of 16,942) were younger, more commonly women, had higher rates of comorbid conditions, and were less likely to receive coronary artery procedures (59.6% vs 70.3%) at index ACS than non-Aboriginal patients. Aboriginal patients waited longer for a booked admission (10th percentile:165days; 95% CI:86-267 versus 47days; 95% CI:43-52) but shorter for an emergency admission (20days; 95% CI:16-25 versus 39days 95% CI:35-44) than non-Aboriginal patients. In the 12 months post-index ACS, Aboriginal patients had 18% fewer elective admissions (p = 0.04) but 46% more emergency admissions (p < 0.001). They had similar LOS for elective admissions (p = 0.427) but 38% greater LOS for emergency admissions (p = 0.007). Conclusions: Following index ACS, Aboriginal patients had higher hospital utilisation for emergency admissions but fewer elective admissions compared to non-Aboriginal patients. More proactive early management and follow-up for Aboriginal patients is needed, including greater understanding of patient- and service-related factors that impede this occurring.

AB - ntroduction: Aboriginal Australians have additive risk for rehospitalisation following an ACS admission including: comorbid conditions, higher rates of complications and discharge against medical advice. We compared hospital utilisation patterns in Aboriginal and non-Aboriginal patients following a first-ever ACS admission (index). Methods: Person-linked hospital records from Western Australia were used to identify CVD admissions in the 12-month period following index ACS in 2007-2010 for patients aged 25-84 years. Outcomes were time to first CVD admission, number of CVD admissions and total length of stay (LOS), comparing Aboriginal to non-Aboriginal patients. We performed separate multivariable regression analyses for elective and emergency admissions accounting for deaths. Results: Aboriginal patients (5.7% of 16,942) were younger, more commonly women, had higher rates of comorbid conditions, and were less likely to receive coronary artery procedures (59.6% vs 70.3%) at index ACS than non-Aboriginal patients. Aboriginal patients waited longer for a booked admission (10th percentile:165days; 95% CI:86-267 versus 47days; 95% CI:43-52) but shorter for an emergency admission (20days; 95% CI:16-25 versus 39days 95% CI:35-44) than non-Aboriginal patients. In the 12 months post-index ACS, Aboriginal patients had 18% fewer elective admissions (p = 0.04) but 46% more emergency admissions (p < 0.001). They had similar LOS for elective admissions (p = 0.427) but 38% greater LOS for emergency admissions (p = 0.007). Conclusions: Following index ACS, Aboriginal patients had higher hospital utilisation for emergency admissions but fewer elective admissions compared to non-Aboriginal patients. More proactive early management and follow-up for Aboriginal patients is needed, including greater understanding of patient- and service-related factors that impede this occurring.

UR - http://www.heartlungcirc.org/article/S1443-9506(17)31209-X/fulltext

U2 - 10.1016/j.hlc.2017.06.670

DO - 10.1016/j.hlc.2017.06.670

M3 - Abstract/Meeting Abstract

VL - 26

SP - S331

JO - Heart, Lung & Circulation

JF - Heart, Lung & Circulation

SN - 1444-2892

IS - Supplement 2

ER -