| Summary: | Acute coronary syndrome (ACS) is globally recognised as a significant health burden, for
which the reduction in total ischemic times by way of the most suitable reperfusion strategy has
been the focus of national and international initiatives. In a setting such as western Australia, characterised
by 79% of the population dwelling in the greater capital region, transfers to hospitals capable
of percutaneous coronary intervention (PCI) is often a necessary but time-consuming reality
for outer-metropolitan and rural patients.
Methods: Hospital separations, emergency department
admissions and death registration data between 1 January 2007 and 31 December 2015 were linked
by the Western Australian Data Linkage Unit, identifying patients with a confirmed first-time diagnosis
of ACS, who were either a direct admission or experienced an inter-hospital transfer.
Results:
Although the presentation rates of ACS remained stable over the nine years evaluated, the rates of
first-time admissions for ACS were more than double in the rural residential cohort, including
higher rates of ST-segment elevation myocardial infarction, the most time-critical manifestation of
ACS. Consequently, rural patients were more likely to undergo an inter-hospital transfer. However,
42% of metropolitan admissions for a first-time ACS also experienced a transfer.
Conclusion: While
the time burden of inter-hospital transfers for rural patients is a reality in health care systems where
it is not feasible to have advanced facilities and workforce skills outside of large population centres,
there is a concerning trend of inter-hospital transfers within the metropolitan region highlighting
the need for further initiatives to streamline pre-hospital triage to ensure patients with symptoms
indicative of ACS present to PCI-equipped hospitals.
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