State of Cardiovascular Health in the NT DR MARCUS ILTON

Transcription

1 State of Cardiovascular Health in the NT DR MARCUS ILTON

2 Background NT Population For whom we provide Cardiac Care Population - 250,000 Darwin - 140,000 Alice Springs - 40,000 Katherine - 10,000 Tennant Creek - 4,000 Nhulunbuy/Gove - 4,000 Average age NT 38 years vs 44 Australia 32% of the population are indigenous Live in remote communities 85% populations from 300 to 3000 Poor levels of housing and infrastructure

3 Population Distribution ATSI Australians Demographics 517, % Australian population % A, 6% TSI, 4% both NSW, Qld, WA, NT, Vic, SA, Tas, ACT Large urban populations Sydney 41,800 Brisbane 41,400 Perth 21,300

4 Population Distribution ATSI Australians High proportions in remote Australia TI region of Qld 83% AS/CA 79% Jabiru/Tiwi/Arnhem 77% 60% TI live in QLD 32% NT population are indigenous

5 Background - Cardiology Department RDH Royal Darwin Hospital 363 bed hospital in Darwin Co-located with the Darwin Private hospital, 104 bed capacity Cardiology Department RDH Part of Cardiac Health Network NT (TEHS and CAHS) TEHS - pop 200,000 Regional Hospitals Katherine District Hospital - pop 10,000 Gove District Hospital - pop 4000 Remote clinics - 51 CAHS - pop 50,000 Regional Hospitals Alice Springs Hospital - pop 40,000 Tennant Creek Hospital - pop 4,000 Remote Clinics - 25

6 What is the Problem we are trying to address? Despite our relatively younger population, the Northern Territory has the highest death rates from coronary artery disease (CAD) in both males and females. The highest death rates in rheumatic heart disease. The higher death rates are seen in both the indigenous and non-indigenous populations.

7 Cardiovascular Disease CVD Cardiac Disease Ischaemic Heart Disease Acute Coronary Syndromes Rheumatic Heart Disease Congenital Heart Disease Heart Failure Cerebrovascular Disease Strokes Peripheral Vascular Disease Aortic aneurysm

8 Burden of CVD Every 10 mins one Australian dies from CVD. CVD is estimated to affect 2 out of 3 Australian families. 16.4% of Australian (3.2million) have CVD and effects of ageing alone this will increase to 24.4% (6.4 million) by 2051 CVD causes 22% Burden of disease in Australia (1in5) 1.1 million Hospitalisation 2x for indigenous populations 30% higher admission and death rates for Regional and remote populations 43% higher death rates and 24% higher admission rates for CVD in lower socioeconomic groups

9 Figure 1: Major causes of CVD death, 2014 Source: AIHW National Mortality Database (Data table).

10 Figure 2: Trends in CVD deaths, by sex, Note: Age-standardised to the 2001 Australian Standard Population. Source: AIHW National Mortality Database (Data table).

11 Figure 3: CVD deaths, by age and sex, 2014 Source: AIHW National Mortality Database (Data table).

12 Figure 4: CVD deaths, by selected population characteristics, Notes Age-standardised to the 2001 Australian Standard Population. Analysis for socioeconomic groups is for 2014 only. Analysis for Indigenous status includes data from NSW, QLD, WA, SA and NT only. Source: AIHW National Mortality Database (Data table).

13 Figure 5: Trends in CHD deaths, Note: Age-standardised to the 2001 Australian Standard Population. Source: AIHW National Mortality Database (Data table).

14 Figure 6: CHD deaths, by age and sex, 2014 Source: AIHW National Mortality Database (Data table).

15 Figure 7: Trends in stroke deaths, Note: Age-standardised to the 2001 Australian Standard Population. Source: AIHW National Mortality Database (Data table).

16 Figure 8: Stroke deaths, by age and sex, 2014 Source: AIHW National Mortality Database (Data table).

17 INDIGENOUS AUSTRALIANS Prevalence 19% of Indigenous Australians report having long-term cardiovascular conditions, similar to that of non-indigenous Australians (17%). Prevalence of indigenous Australians reporting a cardiovascular condition 16% aged years 31% aged 45 to 54 years 47% for those aged 55 years and over.

18 PERSONS REPORTING CARDIOVASCULAR DISEASE, 2001

19

20

21

22 Potential Factors Contributing to worse outcomes for ATSI populations with IHD Increased prevalence at a younger age Inadequate acute treatment Inadequate revascularisation Inadequate long term treatment / education All the above are affected by issues related to: Cultural issues (language / family access) Access Remote, regional or urban Potential for system or institutional rascism.

23 Indigenous Australians are less likely to invasive procedures to treat their coronary heart disease Indigenous Australians hospitalised with CHD 40% less likely to receive PCI 20% less likely to receive CABG age-adjusted rate ratio of 0.6 and 0.8 respectively.

24 Revascularisation for IHD in ATSI population Potential issues limiting the indigenous population access to re vascularisation therapies. Cultural Language Understanding Family Access Regional or remote location System / institutional racism

25 CVD in the Territory Heart Foundation Heart Maps NT Highest all admission rates for CVD across Australia Highest NSTEMI/ STEMI / Unstable angina rates Highest Heart Failure rates Risk Factors Smoking Highest Hypertension and cholesterol lowest Insufficient exercise- highest

26 Rheumatic Heart Disease (RHD) NT: it is likely that between 1% and 4% of children has an undiagnosed RHD If left undetected, many of these children will have continuing disease progression, with the development of cardiac failure over the next decade. (more likely to end up with valve operation)

27 Incidence - ARF Rural NT one of the highest annual incidence in the world 651/100,000 per year data from Carapetis et al 1996 Compared to peak of 242/100, in Melb >95% are indigenous (16x more likely to die ARF/RHD) Point prevalence of 9.6/1000 (indigenous population) Compared to: USA / Japan 0.6/1000 Africa / Asia 15-21/1000 Highest incidence in school aged children

28 ARF Notifications NT ARF Notifications 1 st Jan st March 2017

29 Rheumatic Heart Disease (RHD) NT: it is likely that between 1% and 4% of children has an undiagnosed RHD If left undetected, many of these children will have continuing disease progression, with the development of cardiac failure over the next decade. (more likely to end up with valve operation)

30 NT RHD Diagnoses: 1 st Jan st Mar 2017

31 Proportion of clients Secondary Prophylaxis In NT Clients 45% Secondary prophylaxis in NT clients by adherence category % 35% 30% 25% 20% 15% 100% 80-99% 50-79% < 50% 0% 10% 5% 0% Year

32 RHD deaths 1 st Jan 31 st Mar 2017 Top End Central Australia Aboriginal Other Aboriginal Other female female Sum: female male male Sum: Sum: Sum:

33 Table 1 Death rates from ischaemic heart disease, by sex and state or territory, all ages, 2012 Men and boys Women and girls Total State or territory Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia (195 / in 2001) Source: Australian Bureau of Statistics, Causes of Death, Australia, 2012 Notes: Standardised Death Rates (SDR) are directly age-standardised rates per 100,000 of estimated mid-year population.

34 IHD and the ATSI population. IHD has been identified as a significant contributing factor to the reduced life expectancy of the ATSI population. The same factors that contribute to IHD in the general population are more prevalent in the ATSI population and at a younger age.

35 Aboriginal Mortality Coronary artery disease and stroke are the major specific causes of death for indigenous people. Coronary artery disease - 2 x the death rate Stroke - 2 x the death rate In people aged x the death rate

36

37 ATI males All Aus males 79.5 ATI females All Aus females 84

38 Cardiac Services Across the NT Critical Intervention Points Primary Care Clinics Warning signs Cardiac out reach Regional Hospitals Tertiary Referral Hospital Darwin Interstate Cardiac Rehabilitation Hospital Based Cardiac Outreach

39

40