Heart, lung & circulation
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Rates of acute rheumatic fever and chronic rheumatic heart disease in Aboriginal people, Torres Strait Islanders and Māori continue to be unacceptably high. The impact of rheumatic heart disease is inequitable on these populations as compared with other Australians and New Zealanders. The associated cardiac morbidity, including the development of rheumatic valve disease, and cardiomyopathy, with possible sequelae of heart failure, development of atrial fibrillation, systemic embolism, transient ischaemic attacks, strokes, endocarditis, the need for interventions including cardiac surgery, and impaired quality of life, and shortened life expectancy, has major implications for the individual. ⋯ Underpinning these strategies is the need to improve poverty, housing, education and employment. Cultural empathy with mutual trust and respect is essential. Involvement of Indigenous people in decision making, design, and implementation of primary and secondary prevention programs, is mandatory to reduce the unacceptably high rates of rheumatic heart disease.
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Heart, lung & circulation · May 2010
ReviewImproving cardiovascular care for indigenous populations.
The challenges and opportunities for provision of, and access to, reliable chronic cardiovascular health care for Indigenous people were addressed by expert speakers from New Zealand and Australia. It is well recognised that cardiovascular disease is a life-long concern, requiring reliable follow-up, early transition of clinical research into practice and ongoing support of patients. ⋯ This paper summarises the principal issues identified by the expert speakers for the provision of chronic cardiovascular health care to Indigenous peoples in Australia and New Zealand; identifies common challenges and describes important initiatives which the Cardiac Society of Australia and New Zealand (CSANZ), in partnership with health care professionals, communities and governments, can undertake in order to achieve the goals of uniform and equitable health care for chronic cardiovascular disease in all the Indigenous peoples, relevant to the needs of these peoples, in New Zealand and Australia. The issues addressed by the meeting include: 1) Determination of appropriate models for effective delivery of cardiovascular health care. (2) Who should deliver cardiovascular health care and what are the workforce requirements. (3) What support systems and infrastructure are required. (4) How can primary care and secondary specialist services be effectively integrated.
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Heart, lung & circulation · May 2010
ReviewStrategies to improve indigenous access for urban and regional populations to health services.
Lack of appropriate health service provision for Aboriginal and Torres Strait people still remains and important social determinant of ill health. Historically, health services have been absent or inappropriate. Cultural factors, financial factors and distance from health services have been important barriers limiting Indigenous access to mainstream health services. ⋯ The Adult Health Checks provide an opportunity to evaluate health status, identifying chronic disease risk factors and for implementing preventive care. The Inala Indigenous Health Service has access to the Healthy for Life Program, a Commonwealth funded quality improvement program that has improved health outcomes for patients over the past three years. All primary health care services working in Aboriginal and Torres Strait Islander health settings should have access to funded continuous quality improvement activities.
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Heart, lung & circulation · May 2010
ReviewEstablishment of an innovative specialist cardiac indigenous outreach service in rural and remote Queensland.
Cardiovascular diseases are the leading cause of mortality in Indigenous Australians. Indigneous Australians present at a younger age and have a greater incidence of cardiac risk including smoking and diabetes than non-Indigenous Australians. Access to specialist health services is an important determinant of health care outcomes for these patients. ⋯ Specialist cardiac services and point of care diagnostics have been provided to 18 sites across rural and remote Queensland. More than 1400 episodes of care have been provided to Indigenous Australians with rheumatic heart disease, ischaemic heart disease and congenital heart conditions. Traditional values can work harmoniously with an inclusive medical approach in this relational model.
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Heart, lung & circulation · May 2010
Comparative StudyAcute coronary syndromes in indigenous Australians: opportunities for improving outcomes across the continuum of care.
Amongst a long list of health issues driving the disparity experienced by Indigenous Australians, cardiovascular disease (CVD) remains the primary target. It is the principal cause of death and of excess death among Indigenous people in Australia, and accounts for almost one-third of the life expectancy gap. Most attention has focused on the higher burden of traditional risk factors experienced by Indigenous people to explain CVD disparity. Far less attention has focused on the quality and outcomes of health system performance in explaining these differentials. The CASPA study was a retrospective, mixed-methods clinical registry and quality improvement program established in the NT of Australia, focused on the patterns, burdens, provision of care, experience of services, adverse outcomes and their determinants among 492 patients (214 Indigenous and 278 non-Indigenous). ⋯ Improvements in the delivery of known effective therapies will make a significant impact on adverse outcomes in Indigenous and non-Indigenous patients alike. Comprehensive and sustained prospective data collection to compliment system reform is essential to improve outcomes and reduce disparity in CVD outcomes experienced by Indigenous Australians.