Hospital care and cardiac rehabilitation

Hospitalisation rates for cardiovascular disease (CVD) for Aboriginal and Torres Strait Islander people are high [30593]. Among the specific causes of CVD hospitalisation are coronary heart disease including heart attack, heart failure and cardiomyopathy, stroke, peripheral vascular disease, hypertensive heart disease, and acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

Hospitals play a critical role in improving access to evidence-based care and addressing disparities for Aboriginal and Torres Strait Islander peoples [33654]. For example, research shows that Aboriginal and Torres Strait Islander people hospitalised with heart attack currently:

• do not receive the same rates of important intervention as non-Indigenous patients
• are more likely to die from coronary heart disease while in hospital
• are more likely to leave hospital against medical advice.

In recognition of disparities such as these, many national and local projects are underway to improve hospital care for Aboriginal and Torres Strait Islander cardiac patients [33326][32583][33654][29243]. Improving hospital care focuses on aspects like workforce, care pathways, governance, and cultural competence [33654].

Cardiac rehabilitation – a coordinated program of exercise and education following a heart attack – often begins in hospital and continues when a patient goes home. Cardiac rehabilitation has been shown to be very beneficial following a heart attack, but participation rates of Aboriginal and Torres Strait Islander people are low [33326]. Barriers to participation may include the relatively young age of Aboriginal and Torres Strait Islander heart attack patients, competing family responsibilities, a lack of understanding of cardiac rehabilitation, the distance of a program from a patient’s home, and a program’s lack of cultural safety. Telehealth – including the use of text messaging to deliver lifestyle education following a heart attack – offers one possible solution to some of these barriers.