Cardiology networks: improving the management of acute coronary syndromes

Cardiology networks can encourage appropriate transfer to tertiary care and improve outcomes for acute coronary syndromes

Not only is there a troubling disparity in cardiac health between urban and rural communities,1 there is now considerable evidence that patients who suffer a suspected heart attack (acute coronary syndrome [ACS]) in smaller hospitals in rural areas may not receive state-of-the-art coronary reperfusion treatment2 or optimal care in the medical management of their ACS.3 There is overwhelming evidence that the best treatment for patients with ST-elevation myocardial infarction (STEMI) is coronary reperfusion as soon as possible4 and that the outcome for non-STEMI is better if coronary angiography is performed during the initial hospital admission.5 Unfortunately, timely cardiac catheterisation in a centre capable of percutaneous coronary intervention (PCI) is an ideal not always available. Long distances from rural centres to advanced cardiac care facilities is an Australian reality, and it is unrealistic to hope for sophisticated cardiac facilities in every country town, although there has been successful establishment of regional cardiac facilities in some states. Certain major rural hubs, such as Wagga Wagga, have had cardiac catheterisation facilities since 1997, and many of these centres have been PCI capable for some time.