472 Development of a Rural NSW Cardiac Catheter and Coronary Intervention Service Over 14 Years: Impacts on Service and 30 Day AMI Mortality

Regional Australians have a higher rate of cardiovascular disease and excess mortality for AMI. This has been driven by diminished timely access to cardiac catheterisation. Orange Health Service (OHS) has developed cardiac catheter services in Western NSW LHD, an area of 276,000 km2. Starting as a diagnostic lab in 2005, the service has developed to an FFR/IVUS capable lab providing 24/7 PCI, supporting a centralised smartphone linked acute ECG reading Cardiology service and prehospital lysis for remote STEMI patients. The development of the service, percentage of patients managed in area and improvements in 30 day AMI mortality are described. Database interrogation was conducted within the OHS cardiac catheter unit database and within NSW Bureau of Health Information (BHI) 30 day AMI mortality reports. Total number of cardiac catheterisation rose (835 in 2007 to 1727 in 2019), PCI from 172 in 2007 to 576 in 2019. PCI for STEMI rose from 29 in 2009 to 208 in 2019 and by 2019 89.4% of all ACS were fully managed within the LHD. NSW BHI data showed a drop in 30 day AMI mortality from 7% in 2009- 12 to 4.8% in 2015-18 which was below the NSW average of 5.9%, with OHS being the 7th busiest catheter lab in NSW for AMI with a risk stratified mortality ratio(RSMR) of 0.91 indicated below expected deathrate for casemix. A rural cardiac catheter service providing a centralised STEMI service and 24/7 rescue PCI in a large geographical area, supported by IT and centralised transport systems, can reduce 30 day AMI mortality in a high risk population. Methodologies are applicable to other rural settings.