Patients who go to urban hospitals after having a heart attack receive more timely care than those at rural and urban non-interventional hospitals, new University of Otago research shows.
The study, published in this week’s New Zealand Medical Journal, investigated if there was a difference in the care given to patients who had a heart attack between January 2014 and December 2019 depending on the rural-urban category of the hospital they were first admitted to.
Three hospital categories were considered – large urban interventional, smaller urban non-interventional, and rural hospitals. They were measured on whether patients received an angiography within three days, the assessment of left ventricular ejection fraction (LVEF) and prescription of secondary prevention medication that was prescribed before discharge.
Of the 26,779 patients involved in the national study, 66.2 per cent presented to urban interventional hospitals, 25.6 per cent to urban non-interventional and 8.2 per cent to rural hospitals.
Māori patients were more likely to go to urban non-interventional and rural hospitals than urban interventional.
Lead author Dr Rory Miller, of the Department of General Practice and Rural Health, says patients at rural or urban non-interventional hospitals experienced delays in receiving an angiography and were less likely to receive an echocardiography compared with patients who presented to urban interventional hospitals.
“The findings show people in our rural communities and smaller urban centres are potentially worse off than those in larger, urban settings,” Dr Miller says.
“Māori patients are disproportionately impacted by delays in receiving angiography as they are more likely to live near rural or urban non-interventional hospitals.”
Māori and Pacific patients at urban interventional hospitals were less likely than non-Māori/non-Pacific to receive timely angiography, but more likely to have LVEF assessed.
However, LVEF assessment and timely angiography in urban non-interventional and rural hospitals were lower than in urban interventional hospitals for both Māori and non-Māori/non-Pacific.
The rates of prescribing for secondary prevention medication at discharge were high and similar for all types of hospitals.
Investigations and treatment after non-ST segment elevation acute coronary syndrome for patients presenting to rural or urban hospitals in Aotearoa New Zealand: ANZACS-QI 75
Rory Miller, Garry Nixon, Robin M Turner, Tim Stokes, Rawiri Keenan, Corina Grey, Yannan Jiang, Susan Wells, Wil Harrison, Andrew J Kerr.
New Zealand Medical Journal (Friday 10 November 2023 edition)
For more information please contact
Dr Rory Miller
Department of General Practice and Rural Health
University of Otago