Dawson Luke P, Nehme Emily, Burchill Luke J, Nehme Ziad, O'Brien Jessica, Bloom Jason, Cox Shelley, Anderson David, Stephenson Michael, Lefkovits Jeffrey, Taylor Andrew J, Kaye David, Smith Karen, Stub Dion
Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Lancet Reg Health West Pac. 2023 Jul 4;38:100839. doi: 10.1016/j.lanwpc.2023.100839. eCollection 2023 Sep.
This study examined chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander ('Indigenous') patients presenting to hospital via emergency medical services (EMS) with chest pain.
State-wide population-based cohort study of consecutive patients attended by ambulance for acute chest pain with individual linkage to emergency, hospital admission and mortality data in the state of Victoria, Australia from January 2015 to June 2019. Multivariable models were used to assess for differences in pre-hospital and hospital adherence to care quality, process measures and clinical outcomes.
From 204,969 EMS attendances for chest pain, 3890 attendances (1.9%) identified as Aboriginal or Torres Strait Islander. Age-standardized incidence rates were higher overall for Indigenous people (3128 vs. 1147 per 100,000 person-years, incidence rate ratio 2.73, 95% CI 2.72-2.74), this difference being particularly striking for younger patients, women, and those residing in outer regional areas. In multivariable models, adherence to care quality and process measures was lower for attendances involving Indigenous people. In the pre-hospital setting, Indigenous people were less likely to be provided intravenous access or analgesia. In the hospital setting, Indigenous people were less likely to be seen by emergency clinicians within target time and less likely to transferred following myocardial infarction to a revascularization capable centre.
Incidence of acute chest pain presentations is high among Indigenous people in Victoria, Australia. Opportunities to improve the quality of care for Indigenous Australians presenting with acute chest pain are identified.
National Health and Medical Research Council, National Heart Foundation.
本研究调查了通过紧急医疗服务（EMS）因胸痛入院的原住民和托雷斯海峡岛民（“原住民”）患者的胸痛流行病学及护理质量。
在澳大利亚维多利亚州进行全州基于人群的队列研究，对因急性胸痛呼叫救护车的连续患者进行研究，并将其与紧急情况、住院和死亡率数据进行个体关联，研究时间为2015年1月至2019年6月。使用多变量模型评估院前和院内护理质量、流程指标及临床结局的差异。
在204,969次因胸痛呼叫的紧急医疗服务中，有3890次（1.9%）涉及原住民或托雷斯海峡岛民。原住民的年龄标准化发病率总体较高（每10万人年3128例 vs. 1147例，发病率比值2.73，95%可信区间2.72 - 2.74），这种差异在年轻患者、女性以及居住在偏远地区的人群中尤为显著。在多变量模型中，涉及原住民的呼叫在护理质量和流程指标方面的依从性较低。在院前环境中，原住民获得静脉通路或镇痛治疗的可能性较小。在医院环境中，原住民在目标时间内接受急诊临床医生诊治的可能性较小，心肌梗死后转至具备血管重建能力中心的可能性也较小。
在澳大利亚维多利亚州的原住民中，急性胸痛的发病率较高。本研究确定了改善澳大利亚原住民急性胸痛护理质量的机会。
国家卫生与医学研究委员会、国家心脏基金会。
