OBJECTIVE:The objective of this study was to identify priority social factors contributing to indigenous cardiometabolic diseases. STUDY DESIGN:A three-round Delphi process was used to consolidate and compare the opinions of 60 experts in indigenous cardiometabolic health from Australia, New Zealand and the United States. METHODS:Round one: three open-ended questions: (i) historical, (ii) economic and (iii) sociocultural factor contributors to cardiometabolic disease risk. Round two: a structured questionnaire based on the results from the first round; items were ranked according to perceived importance. Final round: the items were reranked after receiving the summary feedback. RESULTS:Several key findings were identified: (i) an important historical factor is marginalisation and disempowerment; (ii) in terms of economic and sociocultural factors, the panellists came to the consensus that the socio-economic status and educational inequalities are important; and (iii) while consensus was not reached, economic and educational factors were also perceived to be historically influential. CONCLUSION:These findings support the need for multilevel health promotion policy. For example, tackling financial barriers that limit the access to health-promoting resources, combined with improving literacy skills to permit understanding of health education.

Due to confidentiality reasons, the text of this abstract has been withheld from publication.

Background: Whether disparities in the incidence of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal Western Australians persist for disease recurrence is unknown. We used linked data to examine the relationship between Aboriginality and cardiovascular disease outcomes in a population of non-fatal incident cases of AMI in 2000–2004. Methods: This prospective cohort study used person-linked hospital and mortality records to identify 28-day survivors of first-ever AMI (n = 7480) in Western Australia. The outcome measures were: (1) cardiovascular disease death, (2) recurrent admission for AMI, and (3) the composite of (1) and (2). Using Cox proportional hazards regression, we adjusted for demographic and co-morbidity confounders in a progressive manner. Results: Adjusting for demographic variables, the excess risk of death or recurrent AMI in Aboriginals versus non-Aboriginals was 3.6 (95% CI: 2.5–5.3) in men and 4.5 (95% CI: 2.5–7.3) in women. Although younger (median age difference 13 years), the proportion of Aboriginal patients with five-year histories of diabetes and chronic kidney disease were double and triple those of non-Aboriginals respectively. Adjusting for co-morbidities (five-year history), the Aboriginal to non-Aboriginal hazard ratios decreased to 2.3 (95% CI: 1.6–3.0) and 2.4 (95% CI: 1.5–4.0) in males and females respectively. Conclusions: Aboriginality is a significant independent risk factor for re-infarction or cardiovascular death, despite adjustment for demographics and co-morbidity. The high prevalence of diabetes, renal disease and heart failure in Aboriginal people contributes to the disparity in recurrent coronary events, reinforcing the need and importance of multi-sectoral preventive measures in this population.

Objective: Prompt admission to hospital for acute coronary syndrome (ACS) improves outcome. However, median delay times vary from one to 10 hours. We determined the time to hospitalisation from symptom onset, and survival, in Aboriginal and non-Aboriginal admissions for ACS in Western Australia (WA). Methods: Data were collected from medical notes of WA rural and metro hospitals for patients aged 25–79 years with discharge diagnoses of myocardial infarction or unstable angina as emergency admissions in 2002–2004. Combined with data from the WA Data Linkage System, we calculated crude 28-day and 12-month cardiovascular (CVD) mortality, with logistic regression providing adjusted odds ratios. Results: We evaluated 833 Aboriginal and 1469 non-Aboriginal admissions. Median delay time was 3.5 hours in the former and 2.6 hours in the latter. Twelve percent (Aboriginal) and 13% (non-Aboriginal) admissions had delay times of <1 hour. A higher proportion of metro admissions than non-metro had delay times of <4 hours. There was no statistical difference in crude 28-day and 12-month CVD mortality between early (<4 h) and late (≥4 h) presenters by Aboriginality.Tabled 1Crude 28-day CVD mortality12-month CVD mortality<4 h≥4 h<4 h≥4 hNon-Aboriginal6.6%7.8%8.6%10.8%Aboriginal2.7%1.9%5.7%5.3% Open table in a new tab Conclusion: In WA, less than 15% of admissions are within one hour of symptom onset. More than half delay by four hours or more in metro and non-metro patients, especially in Aboriginals. Late presenters (≥4 h) have an apparent higher crude risk of CVD death in non-Aboriginals but not in Aboriginals.

This 'Heart Health' program is an eight-week cycle with no exit date, providing flexibility in program attendance and delivery. Monthly all day sessions are conducted including guest speakers offering practical strategies to participants. Sessions are delivered by Aboriginal staff from DYHS and other organisations in collaboration with non Aboriginal health professionals (cardiac rehabilitation nurse, exercise physiologist, etc).

Introduction: In 2005, NHMRC published an outline of processes to guide services on improving cardiac rehabilitation (CR) for Indigenous Australians. This recognised the increased incidence and mortality from cardiovascular causes in Indigenous Australians with onset occurring at a younger age then in other Australians.

Background: CVD is the leading cause of deaths in Indigenous Australians and a significant cause of Indigenous hospitalization. Although Indigenous clients represent nearly 10% of patient bed days in the RPH Hospital, health care teams in Western Australian hospitals rarely include an Indigenous member. The appointment of an Aboriginal Health Worker for 6 months in the cardiology unit at RPH enabled examination of what difference an Indigenous team member could make.