30 October 2017

Poverty and cardiac disease in the heartland

Cardio Rural

Regional Australians are nearly twice as likely to die from heart disease as their city cousins, with coastal-rural areas in eastern states emerging as the hotspots.

The findings, from the Australian Catholic University’s Mary MacKillop Institute, point to a worsening burden of cardiac disease in regional areas, linked to ageing, lower incomes and lack of access to healthcare services.

By federal electorate, the highest rate of cardiac-related hospitalisations in 2016-17 was recorded in the seat of Lyne, on the NSW mid-north coast, which is held by Assistant Health Minister Dr David Gillespie.

Lyne, with a population of 146,000, led the way with more than 7700 people over the age of 35 admitted to hospital with coronary artery disease, more than 1700 with heart failure and nearly 2500 with atrial fibrillation.

Dr Gillespie, who attended the launch of the report in Canberra, “showed strong interest in the report and is keen to support pertinent initiatives to prevent or reverse the high rates of CAD”, Dr Lei Chen, one of the research team, told The Medical Republic. 

The report’s lead author, Dr Yi-Kai Chan, has asked the federal government to create an expert body to address cardiac disease in the regions and called for the launch of a nurse-practitioner program to prevent and manage heart disease.

Australians who survived a cardiac event would “inevitable develop a chronic and inherently costly form of heart disease that will impair their quality of life and reduce their longevity,” Dr Chan said in the report.

The MacKillop Institute is in the process of forming a committee to liaise with heart research experts to address heart-disease disparity issues, focusing on vulnerable groups including indigenous communities.

The report, called The Heart of Inequality, also found that indigenous people in central Australia developed heart disease 20 years earlier than mainstream society.

Most of the top 10 electorates for cardiac-related hospitalisations were coastal-rural areas, with similar demographic profiles to Lyne.

Lyne was followed by Gilmore, in southern NSW; Hinkler, in central Queensland; Cowper, in NSW just north of Lyne; Flinders, southeast of Melbourne; and Richmond, in northern NSW.

In the hotspot areas, the incidence of hospitalisation was 15% or more above the national average.  In the capital cities, the rate was 15% or less below the average.

Dr David Keegan, a GP in Taree, one of the major centres in Lyne, said the rankings amounted to a “poverty index” but also reflected cutbacks in health services that had benefited the poor.

“The poorest members of the community have carried the weight of the cuts,” Dr Keegan said.

He said low-income patients had poor access to potentially life-saving services such as angiography and stents, which were readily available to private patients. The very ill could be sent south to Newcastle, but with a delay of several hours.

“The medical talent is here, but we don’t have the (public) infrastructure to do what we are trained to do,” Taree cardiologist Dr Seshasayee Narasimhan said.

Dr Narasimhan said the state was spending $2 million a year in housing and transporting cardiac patients to Newcastle.  He is trying to interest authorities, so far without success, in a cost-neutral plan to treat those patients at a fully equipped cath lab at a local private hospital.

Lyne also figured heavily as a risky place to live in the Stroke Foundation’s latest report on stroke and risk factors.

That report said the electorate led the country for incidence of stroke, with a rate of 357 per 100,000 people.  It was home to 4481 stroke survivors, a number projected to more than double by 2050.

Lyne topped the national list for high blood pressure (21.8% of the population), high cholesterol (28%), and atrial fibrillation (3%), the foundation said.  For physical inactivity it came fourth, behind electorates in metropolitan Sydney, Adelaide and Melbourne.