People from non-metropolitan areas have been shown to have poorer cardiovascular outcomes than people in metropolitan areas

There have been changes in the way cardiac services are delivered within Victoria, Australia, since 2012

Analysis of 43,729 myocardial infarction admissions in Victoria from 2012 and 2017 was performed to understand the association between remoteness and clinical outcomes

Remoteness was not associated with changes in clinical outcomes following myocardial infarction, including all-cause mortality and major adverse cardiovascular events

Initiatives such as increasing catheter laboratory access, cardiac rehabilitation and the use of quality registries, may explain the improvements in addressing previous inequalities in clinical outcomes following myocardial infarction

Remoteness has been shown to predict poor clinical outcomes following myocardial infarction (MI). This study investigated 1-year clinical outcomes following MI by remoteness in Victoria, Australia.

We included all admissions for people discharged from hospital following MI between July 2012 and June 2017 (n = 43,729). Remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA). The relationship between remoteness and major adverse cardiovascular events (MACE) and all-cause mortality over 1-year was evaluated using adjusted Poisson regression, stratified by type STEMI and NSTEMI.

For NSTEMI, adjusted rates of MACE were 77.5[95% confidence interval 65.1–92.1] for the most remote area versus 83.4[65.5–106.3] for the least remote area per 1000 person-years. For STEMI, rates of MACE were 28.5[18.3–44.6] for the most versus 33.5[18.9–59.4] for the least remote areas per 1000 person-years. With respect to all-cause mortality, NSTEMI mortality rates were 82.2[67.0–100.9] for the most versus 100.8[75.2–135.1] for the least remote areas per 1000 person-years. For STEMI, mortality rates were 24.7[13.7–44.7] for the most versus 22.3[9.8–50.8] for the least remote per 1000 person-years.

Rates of MACE and all-cause mortality were similar in regardless of degree of remoteness, suggesting that initiatives to increase access to cardiology care in more remote areas succeeded in reducing previous disparities.

Remoteness

Cardiovascular diseases

Myocardial infarction

Secondary prevention

© 2023 The Author(s). Published by Elsevier B.V.