Christopher Conway says rehabilitation is vital. Photo: Simon Schluter
Australians with chest pain and other signs of a heart attack are receiving disturbing variations in care at different hospitals across the country, which may be jeopardising care, experts say.
The first comprehensive audit of how people with acute coronary syndrome are treated in Australia and New Zealand found significant differences in access to best practice treatment such as scans, procedures and the prescription of blood clot busting drugs. It also found vast numbers of people were missing out on rehabilitation programs, including diet and exercise advice, after hospital stays.
Acute coronary syndrome includes any symptom of blocked arteries, including chest pain, nausea and sweating and is commonly known as a heart attack or unstable angina.
Doctors looked at the care of 4398 patients with the syndrome at 286 hospitals over a two-week period in 2012. The hospitals included a mix of private and public hospitals and small, medium and large ones in cities and regional towns.
They found while about 80 to 90 per cent of people would have been expected to receive angiography - an X-ray of the arteries to see if they are narrowed or blocked - this was being done for about 70 per cent of patients in private hospitals, 60 per cent of patients in large ''principal referral'', or public, hospitals and about 40 per cent in regional hospitals. The research said patients in small hospitals were nearly twice as likely to have a major adverse cardiac event such as a cardiac arrest or stroke compared with those in principal referral hospitals.
Lead researcher and professor of cardiology at Flinders University Derek Chew said this was likely to be caused by delays in transferring patients out of smaller hospitals to larger ones better equipped to treat them.
The study also found that while about 70 per cent of patients were being discharged from principal referral hospitals with recommended medications, this dropped to 50-60 per cent of patients being treated elsewhere.
Referrals to rehabilitation occurred for 60 per cent of patients in principal referral hospitals compared with 40 to 50 per cent for all other hospitals, including private hospitals.
The study will be published in the Medical Journal of Australia on Monday. In an editorial about the study, Professor Peter MacDonald, a cardiologist at St Vincent's Hospital in Sydney, and colleagues described the variations as ''disturbing'' and said they should should lead to improvements at underperforming hospitals.
According to the Heart Foundation about 55,000 Australians have a heart attack each year.
Melburnian Christopher Conway, 50, said he was grateful for excellent care at The Alfred when he had a heart attack in 2011. Within 10 minutes of arriving, doctors were performing angiography that led to him having two stents put in his heart to remove a blockage.
Mr Conway said rehabilitation programs were vital. Despite initial reluctance to attend a six-week course, he found it useful to learn about his medications and the boundaries of exercise.
''It was really positive to know that I wasn't alone,'' he said.