A First Nations child born in Australia today can expect to live eight to nine years less than a non-Indigenous child. Throughout their life, they are more prone to suffer a heart attack about 20 years earlier than their non-Indigenous counterparts in the same hospital. They also have a higher risk of acute rheumatic fever, which can damage heart valves, and have higher likelihoods of developing and dying from cancer, diabetes, kidney failure, and lung disease. Additionally, a First Nations Australian is more likely to have a low household income, live in an overcrowded home, and be 14 times more likely to be imprisoned.
It is known that such socioeconomic disparities lead to health disparities, with cultural factors and experiences of racism further worsening the situation. Addressing the health disparities between First Nations peoples and non-Indigenous Australians is a national priority. Improving the hospital care provided to Aboriginal and Torres Strait Islander people is one method for reducing these disparities. At Brisbane’s Princess Alexandra Hospital, staff recognized that the health system was failing to meet the needs of First Nations patients. They embarked on developing a culturally informed care model for First Nations patients with heart disease. Our team has worked with this model and participated in a study that tested it.
Our findings, recently published in The Lancet Global Health, revealed that this culturally informed care model effectively closed the gap in heart health outcomes between First Nations and non-Indigenous patients after hospital discharge. The model was aimed at First Nations patients with acute coronary syndrome, which includes heart attacks and angina caused by arterial disease. First Nations stakeholders helped co-design the project. Tailored training was provided to enhance cultural competence across the cardiology department and to increase staff awareness of services available to First Nations patients outside the hospital.
Staff established formal partnerships with local Aboriginal and Torres Strait Islander community-controlled health organizations and enhanced the hospital environment with First Nations art and uniforms bearing Indigenous flags and artwork. They formed a “Better Cardiac Care” team consisting of an Aboriginal and Torres Strait Islander hospital liaison officer, a cardiac nurse, and a pharmacist. This team visited First Nations patients, offering support, advocacy, education, and care coordination. Patients could ask questions about their diagnosis and treatments without feeling shame or discomfort. The team was focused on meeting patient needs, such as arranging accommodation for a patient’s relative traveling from a distance or notifying a doctor if a patient needed more time to discuss or understand their treatment options.
Before discharge, the team coordinated medication supplies with local pharmacies and scheduled follow-up appointments with GPs. We assessed the care model’s impact by comparing outcomes of First Nations and non-Indigenous patients admitted for heart attacks and angina before and after the model was introduced. We gathered data on 199 First Nations patients and 440 randomly selected non-Indigenous patients from the 24 months before the project and compared them with 119 First Nations patients and 467 non-Indigenous patients from the 12 months afterward. We focused on whether patients died, had another heart attack, needed an unexpected stent or coronary artery bypass surgery, or had to return urgently to the hospital within 90 days of discharge. Prior to the model’s implementation, 34% of First Nations patients experienced one of these negative outcomes, significantly higher than the 18% rate in non-Indigenous patients.
After the model’s introduction, these events occurred in 20% of both First Nations and non-Indigenous patients, marking a substantial improvement for First Nations patients and closing the gap between the groups. The largest improvement was observed in urgent readmissions, but there were also fewer heart attacks. While reducing heart attacks and hospital admissions is positive, it was also vital to ensure that patients felt culturally safe and that their social and emotional needs were addressed. A related project gathered feedback from patients and families about their experience with the care model. The findings suggested that the relationship between patients and the care team, especially Aboriginal and Torres Strait Islander staff, was crucial to its success. Although our study wasn’t a randomized trial and used historical controls, indicating potential influences from other factors, it demonstrated that a culturally informed care model developed with First Nations people’s input can positively impact clinical outcomes. “Better Cardiac Care” programs based on our model have already been adopted in other Queensland hospitals.