Can the Cardiac ARIA Index improve cardiac care for Australia's indigenous population?

Abstract

Background Aims: Timely access to appropriate cardiac care is critical for optimizing outcomes. Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services for Australia’s 20,387 population locations. Methods: An expert panel defined the patient care pathway. Using geographic information systems (GIS) the numeric/alpha index was modeled in two phases. The acute phase index (numeric) ranged from 1 (access to specialist centre with PCI ≤ 1 hour) to 8 (no ambulance service, > 3 hours to medical facility, air transport required). The aftercare index was modeled into 5 alphabetic categories; A (Access to general practitioner, pharmacy, cardiac rehabilitation, pathology ≤ 1 hour) to E (no services available within 1 hour). Results: Approximately 70% or 13.9 million people lived within a Cardiac ARIA category 1A location. Disparity continues in access to category 1A cardiac services for 5.8 million (30%) of all Australians, 60% of Aboriginal and Torres Strait Islander people and 32% of people over 65 years of age. In a cardiac emergency only 40% of the Indigenous population reside within 1 hour of category 1 hospital. Approximately 30% (81,491 Indigenous persons) are more than 1 to 3 hours from basic cardiac services. Conclusion: Geographically, the majority of Australian’s have timely access for survival of a cardiac event. The Cardiac ARIA index objectively demonstrates that the healthcare system may not be providing for the needs of 60% of Indigenous people residing outside the 1A geographic radius. Innovative clinical practice is required to address these disparities.