The Australian research, published in the international medical journal JAMA Cardiology, explored why one-third of patients presenting to hospitals with a serious heart attack known as STEMI do not receive appropriate care.

The study included 29 rural hospitals that operate without emergency medicine specialists.

Researchers randomly assigned 15 facilities to a system that automatically sent a text to a coronary nurse at a major hospital when a patient presented with heart attack symptoms.

The nurses reviewed heart test results to diagnose or rule out the cardiac emergency, and helped the rural hospitals triage patients.

The remaining 14 hospitals operated as normal, with the option to use an existing system allowing rural doctors to contact specialists at major facilities.

Out of 7474 emergency department admissions for suspected heart attacks over 18 months, there were 46 STEMI cases in hospitals linked to the nurses and 77 in the others.

There were no missed diagnoses of the serious heart attacks in hospitals using the nurse notification system, while there were 27 missed cases in those giving routine care.

The study showed there was a higher mortality rate in cases where STEMI went undetected.

Commentary from US physicians said the study, involving researchers from the University of Newcastle and John Hunter Hospital, could have international implications.

"Growing gaps in urban-rural cardiovascular inequity suggest that both policy and clinical interventions are needed," the commentary said.

"The study ... provides an example of what we might hope to achieve for rural patients with cooperation and coordination across geographies."

Australian Associated Press