Heart attack by postcode: how fast and close is due treatment?

How far are you from the treatment you need? Having a heart attack puts the patient in a race against time. Flickr/alexkess

Australians considering where to have a heart attack can now do a postcode check on the speed and quality of medical treatment they are likely to receive.

The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) rates neighbourhoods by the level of emergency and preventative care available in the potentially life-threatening event of a heart attack and afterwards, when residents return home afterwards.

The index was developed over seven years by a multi-disciplinary team led by Associate Professor Robyn Clark of the Queensland University of Technology.

Each location has been given a numeric/alpha rating, with the number showing the proximity of emergency cardiac care, and the letter indicating the accessibility of services which helped prevent a secondary cardiac event. The numeric index ranged from one (access to principal referral centre with cardiac catheterization service up to one hour away) to eight (no ambulance service, more than three hours to a medical facility, with air transport required). The alphabetic index ranged from A (all four aftercare services - family doctor, pharmacy, cardiac rehabilitation, and pathology services - available within a one hour drive) to E (no services available within one hour).

The index can be found here.

With heart damage and associated problems escalating if left untreated, Professor Clark said that the ideal was for the afflicted to receive proper treatement in the “golden hour” - the first 60 minutes following the heart attack.

The NSW Hunter Valley’s “sickest town” of Muswellbrook, home to coal mining and a coal-fired power plant, has a 4A rating, meaning it takes heart attack patients significantly longer to receive the level of care than would someone in the resource-rich Hunter’s “capital”, Newcastle.

Professor Clark said that an hour was also “the maximum length of time people seem willing to travel to get to services that help prevent future secondary attacks after they return home, which occurs in 50% of cases,” Professor Clark said.

Professor Clark said the project found 71 per cent of Australians lived in Cardiac ARIA “1A” locations, which have specialist hospital care and four types of aftercare within one hour’s drive. However, she said, only 68% of people over 65 years of age and 40% of Indigenous people lived within 1A locations.

The findings of Professor Clark’s team “are consistent with the broad 70:30 divide in Australian health”, said Robert Wells, the Director of the Australian Primary Health Care Research Institute and the Menzies Centre for Health Policy at the Australian National University.

“Seventy per cent of people who live in major population centres have reasonable access; the 30% living elsewhere are disadvantaged simply by location,” Mr Wells said.

“The real question is what should be the policy response? Is 70% reasonable access to life-saving care an acceptable situation? If that situation is unacceptable is it feasible to provide more dedicated facilities? One suspects that additional facilities could go some way, but there will be a minimum population catchment to enable facilities to provide a safe level of care – it is not just a question of funding,” Mr Wells said.

The study [by Professor Clark and her team] quotes US data showing they have approximately 80% coverage. Given that the US has a higher proportion of its population in medium size towns, the 80% target (of population with an hour’s travel of dedicated treatment and rehabilitation facilities) is probably too high an expectation for Australia. Perhaps 75% would be Australia’s upper limit,” Mr Wells said.

Policy-makers seeking to improve medical responses and availability must now be informed by more data, such as whether there are heart attack “hot spots”, Mr Wells said.

“We need to have more flexible and innovative responses to improving access critical health services for people , particularly for people in smaller rural and remote communities,” Mr Wells said.

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