Delay times and management of acute myocardial infarction in Indigenous and non‐Indigenous people in the Northern Territory

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Abstract
Objectives To investigate differences in presentation and management of Indigenous and non‐Indigenous patients hospitalised with acute myocardial infarction (AMI). Design Retrospective review of hospital medical records. Participants and setting 122 patients with definite or possible AMI admitted to hospitals in the Top End of the Northern Territory (NT) in 1996. Main outcome measures Percentage receiving thrombolytic therapy; delays from symptom onset to primary and emergency department presentations, first and diagnostic electrocardiograms, thrombolytic therapy and aspirin; drugs prescribed during hospitalisation. Results Thrombolytic therapy was given to 12/41 Indigenous patients (29%) and 38/81 non‐Indigenous patients (47%) (P= 0.06). Presentation delay over 12 hours was the reason for not giving thrombolytic therapy for 14/29 Indigenous patients (48%) and 8/43 non‐Indigenous patients (19%) (P< 0.01). Median delay times were longer for Indigenous patients for all six categories of delay, although the difference was significant only for delay to emergency department presentation (10:00 versus 3:26 hours; P< 0.01) and to diagnostic electrocardiogram (8:10 versus 3:50 hours; P<0.01). Delays were also longer for patients from rural compared with urban areas. Once diagnosed, Indigenous patients were as likely as non‐Indigenous patients to receive aspirin (93% versus 96%) and ‐blockers (70% versus 69%) and more likely to receive angiotensin‐converting enzyme inhibitors (60% versus 40%; P=0.03). Conclusions Delays in presentation affect Indigenous people living in rural and urban areas as well as non‐Indigenous people living in rural areas. Concerted efforts are needed to improve health service access in rural areas and to encourage Indigenous people with persistent chest pain to present earlier.

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