None listed
Conditions
Brief summary
Aboriginal and Torres Strait Islander people die from acute coronary syndrome (ACS), the life-threatening manifestation of ischaemic heart disease, at younger ages than non-indigenous Australians. The reason for this is unknown, as are the risk factors for ACS in Aboriginal and Torres Strait Islander people. This lack of knowledge limits the usefulness of emergency department (ED) risk assessments for Indigenous patients with suspected ACS, which have been developed using data from a general population and are not specific for Aboriginal and Torres Strait Islander people, despite evidence of clear differences in risk for coronary artery disease (CAD) (the underlying cause of ACS) based on ethnic background in no- Aboriginal and Torres Strait Islander cohorts (African-American, Hispanic, Caucasian, Asian). Chest pain risk assessment allows for rapid diagnosis and treatment of ACS and prevention of over-investigation in patients deemed to be "low-risk". In the absence of evidence, current guidelines recommend a cautions approach and consider Aboriginal and Torres Strait Islander patients with chest pain at higher risk of ACS than non-indigenous patients. We will conduct a prospective, cross-sectional study of Aboriginal and Torres Strait Islander people who present to the Cairns Hospital Emergency Department with chest pain. The primary aim is to determine the rate of CAD, measured by coronary artery imaging. Eligible patients will be asked to consent to provide access to their clinical data for the duration of the study. Participants will receive usual clinical care in the ED and be classified as either "high-risk" or 'not high risk". All "not high-risk" participants will undergo an exercise stress test as part of usual care, followed by coronary artery imaging. All patients will be followed-up after two months to record the subsequent occurrence of cardiac death, acute myocardial infraction, urgent/emergency revascularisation, and cardiac re-presentation to the ED and primary care physicians. The cost of health care utilisation over the two months follow-up will also be determined. Participants will be classified as having clinically significant coronary artery disease (>50% stenosis in at least one coronary artery) or not, and as having ACS or not. Demographic and clinical characteristics will be compared between patient groups. We will recruit 80 patients, which will allow us to measure and expected rate of coronary artery disease of 6.3% with 3% precision. The expected findings from this study will 1) allow ED doctors to determine a baseline level of risk of ACS for Aboriginal and Torres Strait Islander patients who present with chest pain, and 2) provide preliminary information necessary for the design of large- scale research studies with the goal of determining specific risk factors and determine optimum investigative strategies for ACS in Aboriginal and Torres Strait Islander people.
Interventions
This research project seeks to determine the rate of coronary artery disease (CAD) for adult Aboriginal and Torres Strait Islander people who present to an Emeregency Department (ED) with symptoms of suspected acute coronary syndrome (ACS). This study will utilise coronary artery imaging investigations to measure the proportion of patients with significant CAD. All participants will receive imaging as part of or in addition to standard investigations for suspected ACS. Participants will be fol
This research project seeks to determine the rate of coronary artery disease (CAD) for adult Aboriginal and Torres Strait Islander people who present to an Emeregency Department (ED) with symptoms of suspected acute coronary syndrome (ACS). This study will utilise coronary artery imaging investigations to measure the proportion of patients with significant CAD. All participants will receive imaging as part of or in addition to standard investigations for suspected ACS. Participants will be followed up after seven days and two months to identify the rate of subsequent major cardiac events (MACE) following the initial presentation to the ED. The research nurse will follow up participants by telephone interview. If the research participant cannot be contacted by telephone, then the research nurse will contact the participant's nominated health service provider with a copy of a consent to release information form to identify whether the participant has had any subsequent cardiac related visits to the health service provider following discharge from hospital.
Sponsors
Dr Katrina Starmer
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients will be included it they: 1. Are aged 18 years and above; 2. Identify as Aboriginal and/or Torres Strait Islander; and 3. Present with symptoms of 5 minutes or more in duration consistent with possible ACS such as chest discomfort or angina equivalent; and/or; emergency physician plans to evaluate the patient for suspected ACS.
Exclusion criteria
Patients will be excluded from the research study if: 1. They are pregnant or lactating; 2. They are less than 18 years of age; 3. The researcher feels that recruitment is inappropriate (e.g. Terminal illness); 4. They (or legal representative) are unable or unwilling to provide informed consent; 5. They (or legal representative) refuse to be followed-up by telephone or medical record review after 7 days, or they are unlikely to be contactable e.g. they will be overseas; 6. They have a clear alternative non-ACS diagnostic cause for symptoms; 7. They have a know allergy or contraindication to iodinated contrast precluding CTCA/ICA; 8. They have a known allergy or contraindication to beta-blockade medication precluding CTCA/ICA; 9. They have severe or restrictive airways disease or acute exacerbation precluding CTCA/ICA; 10. They have significant renal impairment precluding CTCA/ICA; or 11. They have been recruited to this research project within the last 12 months.
Outcome results
None listed