436 A Rural 24/7 Cardiac Catheter Lab Service in Western NSW Local Health District (WNSWLHD): Locally Based Acute Coronary Syndrome (ACS) Care with Low Mortality over 5 Years

Patients from rural areas carry a high burden of cardiovascular (CV) risk factors [1Kotwal S, Ranasinghe I, Brieger D, Clayton P, Cass A, Gallagher M. Long-term outcomes of patients with Acute Myocardial Infarction presenting to regional and remote hospitals. Heart Lung Circ. 2016 Feb;25(2):124-131.Google Scholar, 2AIHW Heart Stroke and vascular diseases July 2018.Google Scholar, 3Bureau of Health InformationMortality following hospitalisation for seven clinical conditions, July 2015–June 2018. BHI, Sydney (NSW)2019Google Scholar]. Rural STEMI patients presenting to non PCI-capable sites have a 21% higher mortality at 18 months [[4]Breiger DB, Chew DP, Redfern J, Ellis C et al MJA Nov 2015 Survival after an acute coronary syndrome:18 month outcomes from the Australian and New Zealand SNAPSHOT ACS Study.Google Scholar]. Orange Health Service (OHS) has provided a centralised cardiology service and rescue PCI to WNSWLHD, spanning an area roughly 250,000km2, since 2015. A retrospective, analysis was conducted of rates of PCI for ACS within WNSWLHD throughout 2015-19. LHD performance in BHI 30 day AMI mortality reports were examined. Cardiac catheterisation increased (1367 in 2015 to 1727 in 2019). Percentage of locally managed ACS cases rose from 84.1% (n=614) in 2015 to 89.4% (n=981) in 2019. STEMIs rose from 163 in 205 to 208 in 2019, with a larger percentage admitted directly to the PCI centre. (65% 2015-18; 45% 2012-15; 26% 2009-12). The BHI 2015-18 report showed OHS managed 1298 AMIs, the 7th highest lab volume in NSW. Mortality remained below state average (OHS 4.8%; NSW wide 5.9%). The risk-standardised mortality ratio (RSMR) of 0.84 (<1.0) indicated lower than expected mortality for casemix. This compares to 894 AMIs 2012-2015 (mortality 4.7% (RSMR 0.84)) and 470 AMIs 2009-2012 (7% mortality (RSMR 0.95)). The 24/7 ECG reading and rescue-PCI service, has led to increased volume and complexity of cardiac catheterisation for AMI at OHS with an increasing percentage of patients managed within WNSWLHD. This has been achieved safely, with decreasing BHI 30 day mortality corrected for casemix, driven by centralisation of STEMI management.