New research shows no geographic disparity in outcomes following heart attack care

Thursday 7 December 2023

A major worry of some regional and rural patients is what could happen to them when they go home following a heart attack. Grampians Health clinician-researcher Adam Livori wanted to make sure his patients had the best outlook after being discharged from hospital and dove into research to see what the numbers said about it.

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

In the past, remoteness has been shown to predict poor clinical outcomes for patients the further away they are from a major metropolitan area.  

"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, because 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," Mr Livori said.  

Mr Livori wanted to know whether a patient's distance from a capital city would increase the risk of poor outcomes after a patient was discharged from hospital following a heart attack.  

"The first question of my PhD was 'Should the view from your window determine outcomes following an admission for myocardial infarction?'.  

"My aim was to quantify clinical outcomes following heart attack between regional and metropolitan areas in Victoria," said Mr Livori.  

The study is a linked data project that looked at all Victorian myocardial infarction admissions between 2012 and 2017 which was then mapped to patients' locations in Victoria. Mr Livori, as part of a Monash University team from the Centre for Medicine Use and Safety, applied different statistical techniques to help project and predict outcomes across the scale of remoteness using the accessibility/remoteness index of Australia, which considers the distances of different services available to communities.  

"We know since 2012, when the dataset from our study began, access to catheter laboratory services for myocardial infarctions has increased. In fact, 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. So, the question posed was 'Does this disparity between remoteness and clinical outcomes following a heart attack still exist?'," Mr Livori said.  

Surprisingly, his research found that a patient's distance from a major regional centre or capital city had no effect on clinical outcomes. 

"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.  

"So, whether you've had your heart attack in Ballarat, in Richmond, or whether you've had your heart attack out past Warrnambool, the likelihood of you having died altogether, having a cardiovascular death, admission for heart attack, admission for stroke or heart failure, is the same," said Mr Livori.  

His research highlights the importance of investment into regional cardiology care since 2012. This shows the importance of regionally-based cardiology care, use of registry data to support outcomes, and the use of high-level statistical analysis of real-world data to understand patterns and predictors of clinical outcomes following myocardial infarction.  

"What's the takeaway from this? What it tells us is that individuals who are working within our health services across Victoria, the initiatives being implemented at a system level are working, because disparities previously reported no longer exist,” Mr Livori 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."  

Mr Livori’s research has been recently accepted for publication in the International Journal of Cardiology. 

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