None listed
Conditions
Brief summary
The Powerful Pictures study is an ambitious project which seeks to partner with First Nations Australians to co-design a new, improved model of care to identify and manage heart disease in patients at risk of future heart attacks. This model of care includes increasing access to a high-quality imaging test, Computed Tomography Coronary Angiography (CTCA) for the detection of early heart disease. The Powerful Pictures model of care will be co-designed with local communities, patients with lived experience of a possible heart attack, local clinicians, health workers, and health services managers and leadership. The model will then be implemented in regional (Cairns), outer regional (Atherton and Mareeba) and remote (Weipa) hospitals across Far North Queensland
Interventions
In the intervention period, patients will be offered assessment in the new model of care which includes a radiological examination: computer tomography coronary angiogram (CTCA).. The model of care will be based upon the existing clinical assessment pathway for suspected acute coronary syndrome with the inclusion of CTCA and Calcium scoring (instead of exercise stress test). The co-design process for the model of care involves up to 36 consenting participants taking part in a one-hour qualitat
In the intervention period, patients will be offered assessment in the new model of care which includes a radiological examination: computer tomography coronary angiogram (CTCA).. The model of care will be based upon the existing clinical assessment pathway for suspected acute coronary syndrome with the inclusion of CTCA and Calcium scoring (instead of exercise stress test). The co-design process for the model of care involves up to 36 consenting participants taking part in a one-hour qualitative interview to discuss elements of the model of care. Model of care elements include recruitment strategies, sharing of test results and education information with patients, linking of patients with existing or new primary care providers and other follow-up processes. Following the co-design process, the new model will be implemented. Eligible participants for the new model of care will be identified by either senior clinical staff or directly by research staff. Research staff will approach potential participants and invite them to consent to take part in the research project as soon as possible but up to seven days following their index presentation During the implementation period, consenting participants will receive a single CTCA scan procedure, lasting approximately 30 minutes, as either an inpatient or as soon as possible following their ED visit dependent on facility availability for testing. CTCA's will be conducted by trained radiology staff within the established service. The examination will include a non-contrast ECG-triggered acquisition for calcium scoring followed by a post-contrast ECG -gated acquisition covering the whole of the heart and the root of the aorta. The total radiation dose is anticipated to be <5mSv and will be monitored. An iodine-based contrast agent will be administered intravenously using the standard local procedure. The use of glyceryl trinitrate (GTN) for coronary artery dilatation will be used routinely and beta-blockers, or other rate-limiting drugs, may be administered to achieve a resting heart rate pre-acquisition <65 bpm.
Sponsors
Queensland University of Technology
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1) Identifies as Aboriginal and Torres Strait Islander origin 2) Presentation to an emergency department 3) Treating clinicians intends to investigate for possible acute coronary syndrome
Exclusion criteria
1) Diagnosis with acute myocardial infarction (AMI) during index presentation 2) Planned to undergo invasive coronary angiography 3) Known contradiction to CTCA: Severe renal failure; (serum creatinine >250 µmol/L or estimated glomerular filtration rate <30 mL/min/1.73 m2; contrast allergy; documented intolerance to rate limiting agent available; inability to breath hold; and atrial fibrillation (where mean heart rate is anticipated to be greater than 65/bpm after beta blockade) 4) History of previously documented coronary artery disease on invasive coronary angiography or CTCA
Outcome results
None listed