The Centre of Research Excellence (CRE) to Reduce Inequality in Heart Disease focuses on improving the heart health and outcomes of groups and communities i.e. Regional Australians, Indigenous Australians and International Health

Central Australia Heart Protection study

Research Stream: Indigenous Australians

 

CAHPSLogo.jpg - largeLeading on from the Heart of the Heart Study [1] and other surveillance trials led by Professor Brown, this ongoing study addresses high rates of death and disability associated with acute coronary syndrome (from unstable angina to acute myocardial infarction) in Central Australia.

  

Full Study Title

Central Australia Heart Protection Study

Twekerte Marra Ka

 

Funding Source

National Health and Medical Research Council Project Grant (2011 - 2015) number 1006051

 

Rationale for the Study

The Central Australian Secondary Prevention of Acute Coronary Syndromes (CASPA) Project measured the quality of care for individuals suffering an Acute Coronary Syndrome (ACS) event and mapped the proportion of patients experiencing pre-defined clinical outcomes, receiving standard processes of care, and achieving secondary prevention targets. Overall, 492 patients experiencing ACS from across the NT were tracked from onset of symptoms to 4 years post-discharge.Throughout hospitalisation there were differences in the delivery of evidence-based care according to ethnicity. For example, Indigenous patients were less likely to be discharged on lipid lowering therapy. However, the greatest differences were observed in outcomes. In those discharged alive, Indigenous patients were significantly more likely to die from all-cause (30.0% v 17.8%; p=0.002), or from a CVD event (17.0% v 9.9%; p=0.026) within 2-years. In multivariate analyses, controlling for demographic, clinical, in-hospital and discharge treatment, Indigenous males were 4 times more likely to die and females 2 times more likely to die following ACS than their non-Indigenous counterparts.[2,3]

 

Study Aims

To develop a cost-effective, culturally sensitive and flexible model (involving a strong element of family based intervention) of health support for individuals (both Indigenous and Non-Indigenous) hospitalised with a diagnosis of ACS at the Alice Springs Hospital.

 

Study Hypothesis

Patients discharged from Alice Springs Hospital with a confirmed diagnosis of ACS randomised to a nurse-led, family-based secondary prevention program will have 15% fewer major cardiovascular events over 2-years compared to those randomised to usual post-discharge management.

 

Alongside the primary hypothesis, the secondary hypotheses outline that recruitment of a family member within the stepped care, nurse led intervention will:

  1. Increase the proportion of post-ACS patients achieving clinical targets (BP, lipids);
  2. Reduce the proportion of post-ACS patients who are smoking at 6 and 24 months; and
  3. Reduce the family members’ cardiovascular risk score (as measured by the Framingham Risk Equation)

Study Design

This is a single-centre, randomised controlled trial. It conforms to the principles outlined in the Declaration of Helsinki and to the CONSORT guidelines for a pragmatic study comparing the efficacy of two non-pharmacological health interventions.

 

Primary and Secondary Outcomes

The primary endpoint for this study is a major cardiovascular event (defined as death, non-fatal ACS, stroke, or unplanned revascularisation) during 2-year follow-up. Endpoints will be examined on an individual basis and adjudicated by a blinded Study End-Point Committee.

 

The secondary endpoints are change from baseline to two years in the following variables:

 

Patient:

    1. Verification of evidence based care (prescription of lipid lowering, anti-platelet, BP lowering and other therapies).
    2. Achievement of clinical targets - BP, lipid fractions (TC, HDL-C, LDL-C, and triglycerides), glycosylated haemoglobin (HbA1c), and anthropometric measures (weight, waist and hip circumference).
    3. Psychosocial status (depression score).
    4. Reduction of adverse behavioural risk factors – nutritional status, smoking, alcohol consumption and physical activity.    

Health System:

    1. CVD-related and all-cause hospital admissions and related hospital stay, in addition to patterns of community care and treatments over 2 year follow-up.

 

Family members of the index patient (nurse-led intervention arm only): to determine the impact of family involvement in secondary prevention, secondary end-points focussing on the CV status of at least one family member of each index ACS patient within the intervention arm will be determined. This will include measurements of:

    1. Baseline and 2-year absolute cardiovascular risk score (measured with Framingham Risk Equation).
    2. Proportion receiving evidence based care for managing cardiovascular risk and disease (prescription of lipid lowering, anti-platelet, BP lowering and other therapies).
    3. Proportion with hypertension, dyslipidaemia, abdominal obesity, elevated BMI and smoking at each time point.
    4. Proportion with adverse behavioural risk factors – nutritional status, smoking, alcohol consumption and physical activity.

 

Study Status

Recruitment into the study has proved to be challenging from the perspective of a changing case-mix of patients admitted to the Alice Springs Hospital with an ACS. Recruitment will be completed by the end of 2013 (an updated report on the study will then be posted).

 

Ongoing Research

N/A

 

Key Collaborators

  • Professor Alex Brown: SAHMRI, South Australian Health and Medical Research Institute, Aboriginal Research Unit
  • Professor Simon Stewart: Australian Catholic University, Australia
  • Associate Professor Melinda Carrington: Australian Catholic University, Australia
  • Professor Sandra Eades: The University of Sydney, Sydney School of Public Health
  • Prof David Thompson: Australian Catholic University, Cardiovascular Research Centre
  • Associate Professor: Christopher Zeitz: The University of Adelaide

 

Key References

  1. McGrady M, Krum H, Carrington MJ, Stewart S, Zeitz C, Lee GA, Marwick TH, Haluska BA, Brown A. Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study. Heart. 2012;98(21):1562-7.
  2. Brown A. Bridging the Survival Gap Between Indigenous and Non-Indigenous Australians: Priorities for the Road Ahead. Heart, Lung and Circulation 2009;18(2):96-100.
  3. Brown A. Acute Coronary Syndromes in Indigenous Australians: Opportunities for Improving outcomes across the continuum of care. Heart, Lung and Circulation 2010; 19(5-6);325-336.

 Publications

N/A