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https://hdl.handle.net/2440/89617
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dc.contributor.author | Tideman, P. | - |
dc.contributor.author | Tirimacco, R. | - |
dc.contributor.author | Senior, D. | - |
dc.contributor.author | Setchell, J. | - |
dc.contributor.author | Huynh, L. | - |
dc.contributor.author | Tavella, R. | - |
dc.contributor.author | Aylward, P. | - |
dc.contributor.author | Chew, D. | - |
dc.date.issued | 2014 | - |
dc.identifier.citation | Medical Journal of Australia, 2014; 200(3):157-160 | - |
dc.identifier.issn | 1326-5377 | - |
dc.identifier.issn | 0025-729X | - |
dc.identifier.uri | http://hdl.handle.net/2440/89617 | - |
dc.description.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. | - |
dc.description.statementofresponsibility | Philip A Tideman, Rosy Tirimacco, David P Senior, John J Setchell, Luan T Huynh, Rosanna Tavella, Philip E G Aylward, Derek P B Chew | - |
dc.language.iso | en | - |
dc.publisher | MJA Group Australia | - |
dc.rights | Copyright status unknown | - |
dc.source.uri | http://dx.doi.org/10.5694/mja13.10645 | - |
dc.subject | Humans | - |
dc.subject | Myocardial Infarction | - |
dc.subject | Coronary Angiography | - |
dc.subject | Risk Assessment | - |
dc.subject | Length of Stay | - |
dc.subject | Patient Transfer | - |
dc.subject | Comorbidity | - |
dc.subject | Hospitals, Rural | - |
dc.subject | Cardiac Care Facilities | - |
dc.subject | Rural Health Services | - |
dc.subject | Rural Population | - |
dc.subject | Primary Health Care | - |
dc.subject | Health Services Accessibility | - |
dc.subject | South Australia | - |
dc.title | Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.5694/mja13.10645 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Tavella, R. [0000-0002-4869-465X] | - |
Appears in Collections: | Aurora harvest 7 Medicine publications |
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