Contextualising acute coronary syndrome standards and guidelines for Aboriginal people residing in Central Australian and Top End Aboriginal communities.

Abstract

Introduction: The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndrome 2016 (in consultation with the Australian and New Zealand Society of Cardiac and Thoracic Surgeons) provide guidelines for the management of myocardial revascularisation. In addition, the European System for Cardiac Operative Risk Evaluation (euroSCORE I and II) are models used to calculate risk of mortality 30 days post cardiac surgery. The euroSCORE I and II have been validated for European, Japanese and North American populations; however, they have not been validated for Aboriginal and Torres Strait Islander populations and there is still much debate on whether they can be attributed to this, and other Indigenous populations. This study aims to explore the contextual factors (barriers and enablers) informing the guidelines for cardiac surgery and revascularisation for Aboriginal and Torres Strait Islander people residing in central Australian and Top End Northern Territory communities. Subsequently, recommendations will be put forward for culturally effective cardiac pathways of care. Methodology: This study uses an Indigenous research methodology, through the lens of the Essential Service Standards for Equitable National Cardiovascular Care (ESSENCE) framework, to better understand Aboriginal world views and experiences of cardiac surgery. Data collection: Semi-structured and/or open-ended questions will be posed 30-90 days post-discharge from Flinders Medical Centre and used to elicit free flowing narratives and storytelling once the participant is back residing in their community. Analysis: Indigenous narrative analysis, by means of storytelling, will be used to develop themes and codes for the purpose of identifying "experience" commonalities and distinctions and mapped to relevant acute coronary syndrome (ACS) and revascularisation standards and guidelines. Conclusion: The practical outcomes of the proposed study will identify cultural service gaps to make recommendations aligned to revised recommendations for new ACS and revascularisation standards, guidelines and care pathways for Aboriginal and Torres Strait Islander populations.