Heart, Lung and Circulation

Wandering Hearts: Acute Cardiac Management in the Regional Setting

      Evidence has demonstrated the disparity between the burden of disease for rural and urban Australians. Many studies have investigated the cause and ramifications of this disparity. However, few have sought to clarify the efficacy of treatment for rural Australians during an acute myocardial infarction (AMI). Extant literature, related to treatment of cardiovascular disease (CVD), discusses guidelines for treatment and follow-up requirements. A vast majority of this discussion centres on the urban experience. This study investigates concordance with treatment guidelines for AMI from a rural perspective.
      A quantitative, retrospective study was undertaken. A review of 204 medical files was conducted, which included all chest pain and angina admissions to a rural base hospital over a 12 month period. The study used a specifically constructed audit tool, which sought to capture patient demographics, clinical findings and concordance with treatment guidelines. Significant correlations between clinical findings and transfer for treatment were analysed using Pearson's Correlations and Regression analysis.
      The results indicated that age (p < 0.001), employment status (p < 0.01) and acute ECG changes (p < 0.01) were significant determinants for patients transferred and those patients treated regionally. There was no evidence of differences in medical intervention for those patients transferred when compared to those not transferred. Concordance with consensus guidelines for acute cardiac care ranged from 70 to 79% across both groups. Given that these research findings demonstrate concordance with the treatment guidelines other services that would reduce the need for unplanned cardiac presentations need to be considered.