Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/89617
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Type: Journal article
Title: Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction
Author: Tideman, P.
Tirimacco, R.
Senior, D.
Setchell, J.
Huynh, L.
Tavella, R.
Aylward, P.
Chew, D.
Citation: Medical Journal of Australia, 2014; 200(3):157-160
Publisher: MJA Group Australia
Issue Date: 2014
ISSN: 1326-5377
0025-729X
Statement of
Responsibility: 
Philip A Tideman, Rosy Tirimacco, David P Senior, John J Setchell, Luan T Huynh, Rosanna Tavella, Philip E G Aylward, Derek P B Chew
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.
Keywords: Humans; Myocardial Infarction; Coronary Angiography; Risk Assessment; Length of Stay; Patient Transfer; Comorbidity; Hospitals, Rural; Cardiac Care Facilities; Rural Health Services; Rural Population; Primary Health Care; Health Services Accessibility; South Australia
Rights: Copyright status unknown
RMID: 0030022866
DOI: 10.5694/mja13.10645
Appears in Collections:Medicine publications

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