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
Research Stream: Indigenous Australians
Leading on from the Heart of the Heart Study  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.
Central Australia Heart Protection Study
Twekerte Marra Ka
National Health and Medical Research Council Project Grant (2011 - 2015) number 1006051
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]
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.
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:
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.
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:
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:
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).