Overcoming the tyranny of distance: An analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high-risk individuals living in Central Australia

Objectives: We examined the logistical challenges of conducting an outreach, secondary prevention program for adults discharged from Alice Springs Hospital following an acute presentation of cardiovascular disease. Design and Setting :This represents a sub-study of the Central Australian Heart Protection Study ( CAHPS ). Clinical, logistic and demographic data were used to examine the characteristics of outreach visits in the intervention arm of the study. Participants: Fifty subjects initially allocated to the intervention arm of the trial were studied. Main outcome measures: Completion of scheduled, plus additional outreach visits according to the intervention protocol. Results: The majority of subjects presented with an acute coronary syndrome ( 44/50 ( 88% ) ) and 31 ( 62% ) were of Indigenous ethnicity. However, Indigenous subjects being younger ( 53.1 ± 11.1 versus 58.0 ± 11.0 years non-Indigenous ) had a more complex risk factor and co-morbid profile, with significantly more diabetes ( 77% versus 26% P  <  0.001 ), hypertension ( 81% versus 53% P = 0.04 ) and renal failure ( 52% versus 21% P = 0.03 ). Community of origin of Indigenous subjects was 230 ± 208 km from the hospital versus 61 ± 150 km for non-Indigenous subjects ( P = 0.004 ). Indigenous subjects missed a significantly higher number of scheduled visits at six months ( 1.39 ± 2.14 versus 0.16 ± 0.50 visits; P = 0.02 ). However, multivariate analyses suggested that distance did not influence successful completion of visits. Conclusions: These early findings from CAHPS are invaluable to understanding and improving the feasibility of secondary prevention programs for Indigenous adults living with heart disease in remote communities.