Cardiac Surgery in Indigenous Australians – How Wide is ‘The Gap’?

• Published in: Heart, lung & circulation Vol. 23; no. 3; pp. 265 - 272
• Main Authors: Wiemers, Paul, MBBS, Marney, Lucy, MBBS, Muller, Reinhold, PhD, Brandon, Matthew, MBBS, Kuchu, Praveen, MBBS, Kuhlar, Kasandra, MBBS, Uchime, Chimezie, MSc, MBBS, Kang, Dong, FRACS, White, Nicole, PhD, Greenup, Rachel, BN, Fraser, John F., PhD, FCICM, Yadav, Sumit, FRACS, Tam, Robert, FRACS
• Format: Journal Article
• Language: English
• Published: Australia Elsevier B.V 01.03.2014
• Subjects: Age Factors; Australia; Australia - epidemiology; Cardiac Surgical Procedures; Cardiovascular; Coronary artery disease; Coronary Artery Disease - ethnology; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Disease-Free Survival; Humans; Indigenous population; Oceanic Ancestry Group; Outcomes; Retrospective Studies; Rheumatic heart disease; Rheumatic Heart Disease - ethnology; Rheumatic Heart Disease - mortality; Rheumatic Heart Disease - surgery; Risk Factors; Survival Rate; Australia; Cardiac surgical procedures; Rheumatic heart disease; Australia; Indigenous population; Coronary artery disease; Outcomes
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2013.09.002

Background Cardiovascular disease remains the leading cause of mortality in the Indigenous Australian population. Limited research exists in regards to cardiac surgery in the Aboriginal and Torres Strait Islander (ATSI) population. We aimed to investigate risk profiles, surgical pathologies, surgical management and short term outcomes in a contemporary group of patients. Methods Variables were assessed for 557 consecutive patients who underwent surgery at our institution between August 2008 and March 2010. Results 19.2% (107/557) of patients were of Indigenous origin. ATSI patients were significantly younger at time of surgery (mean age 54.1 ± 13.23 vs. 63.1 ± 12.46; p = <0.001) with higher rates of preventable risk factors. Rheumatic heart disease (RHD) was the dominant valvular pathology observed in the Indigenous population. Significantly higher rates of left ventricular impairment and more diffuse coronary artery disease were observed in ATSI patients. A non-significant trend towards higher 30-day mortality was observed in the Indigenous population (5.6% vs. 3.1%; p = 0.244). Conclusions Cardiac surgery is generally required at a younger age in the Indigenous population with patients often presenting with more advanced disease. Despite often more advanced disease, surgical outcomes do not differ significantly from non-Indigenous patients. Continued focus on preventative strategies for coronary artery disease and RHD in the Indigenous population is required.