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Indigenous Better Cardiac Care measure: 3.1-Hospitalised ST-segment-elevation myocardial infarction events treated by percutaneous coronary intervention, 2016

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this term3.1-Hospitalised STEMI treated by PCI, 2016
METeOR identifier:Help on this term657003
Registration status:Help on this termHealth, Standard 17/08/2017
Description:Help on this term

Proportion of hospitalised ST-segment-elevation myocardial infarction (STEMI) events among people aged 18 and over for which percutaneous coronary intervention (PCI) was provided, by Aboriginal and Torres Strait Islander status.

Rationale:Help on this term

This measure falls within Priority area 3 of the Better Cardiac Care project—guideline-based therapy for acute coronary syndrome (ACS). This priority area is based on the premise that all Aboriginal and Torres Strait Islander people with ACS should receive guideline-based therapy.

ACS is a broad spectrum of acute clinical presentations, ranging from unstable angina to acute myocardial infarction. The National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the management of acute coronary syndromes are described in Aroney et al. (2006), Aroney et al. (2008) and Chew et al. (2011).

When a person has a heart attack where the artery supplying an area of heart muscle is blocked, where clinically appropriate, the patient should be offered PCI to restore blood flow. In general, if access to PCI is not available within recommended timeframes, a blood clot-dissolving medicine (fibrinolysis) should be offered (ACSQHC 2014).

The measure reported for this indicator (as described in this specification) is different from the agreed measure (see AIHW 2016 for details). Specifically, the agreed measure for this indicator is:

  • Proportion of people with STEMI who present within 12 hours of symptom onset and are eligible to receive emergency reperfusion therapy who are:

(i) treated by primary PCI and/or

(ii) treated with fibrinolysis

by Aboriginal and Torres Strait Islander status.

Full reporting against this indicator is not possible using available data. Data are not available to assess whether patients present to emergency departments within 12 hours of symptom onset, nor on whether patients are eligible for reperfusion.

The reported measure excludes people aged under 18 due to small numbers.

Indicator set:Help on this termBetter Cardiac Care measures for Aboriginal and Torres Strait Islander people (2016) Health, Standard 17/08/2017

Collection and usage attributes

Population group age from:Help on this term

18 years

Computation description:Help on this term

Number of hospitalised STEMI events among people aged 18 and over for which PCI was provided, divided by the number of hospitalised STEMI events among people aged 18 and over, and multiplied by 100.

Data are presented as a percentage.

Crude rates are calculated for Indigenous Australians.

Age-standardised rates are calculated for comparisons between Indigenous and non-Indigenous Australians, and for analysis of change over time.

Data are based on financial years.

Definitions:

Hospitalised STEMI event—in the context of this measure, refers to an episode of care for an admitted patient with a principal diagnosis of STEMI (see definition below), a care type of 'acute care', an urgency of admission of ‘emergency’, and a separation mode not equal to 'transferred to (an)other acute hospital'.

Hospitalisation (separation)—an episode of care for an admitted patient that can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of care type (for example, from acute care to palliative care).

ST-segment-elevation myocardial infarction (STEMI)—a type of heart attack. Heart attacks are divided into two types, according to their severity; a STEMI is the more severe type. Identified as those separations with a principal diagnosis of ICD-10-AM (8th edn.) codes I21.0, I21.1, I21.2 or I21.3.

Treated by PCI— a surgical procedure used to restore blood flow to blocked coronary arteries, two types are used: coronary angioplasty without stent, and coronary stenting. Relevant Australian Classification of Health Interventions (ACHI) procedure codes (8th edn.) are: 38300-00, 38300-01, 38303-01, 38306-03, 38306-04, 38306-05, 38303-00, 38306-00, 38306-01, 38306-02, 38312-00, 38312-01, 38315-00, 38309-00, 38318-00, 38318-01, 38505-00, 90218-00, 90218-01, 90218-02, 90218-03.

Principal diagnosis—the diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care.
Computation:Help on this term

Crude rate: (Numerator ÷ Denominator) x 100

Age-standardised rate: calculated using the direct method, and the Australian standard population as at 30 June 2001.

Numerator:Help on this term

Number of admitted patient separations in the reference period among people aged 18 and over with a principal diagnosis of STEMI (see ‘Computation description' for definition), a care type of ‘acute care’, an urgency of admission of ‘emergency’, and separation mode not equal to ‘transferred to (an)other acute hospital’, with a procedure code for PCI (see ‘Computation description’ for definition).

Numerator data elements:Help on this term
Data Element / Data SetEpisode of care—principal diagnosis, code (ICD-10-AM 8th edn) ANN{.N[N]}
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetEpisode of admitted patient care—separation mode, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetHospital service—care type, code N[N]
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetEpisode of admitted patient care—admission urgency status, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetPerson—date of birth, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data

Used together with date of admission for calculation of age.


Data Element / Data SetEpisode of admitted patient care—admission date, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data

Used together with date of birth for calculation of age.


Data Element / Data SetEpisode of admitted patient care—procedure, code (ACHI 8th edn) NNNNN-NN
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Administrative by-product data


Denominator:Help on this term

Number of admitted patient separations in the reference period among people aged 18 and over with a principal diagnosis of STEMI, a care type of ‘acute care’, an urgency of admission of ‘emergency’, and separation mode not equal to ‘transferred to (an)other acute hospital’.

Denominator data elements:Help on this term
Data Element / Data SetEpisode of admitted patient care—separation mode, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetHospital service—care type, code N[N]
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetEpisode of admitted patient care—admission urgency status, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetPerson—date of birth, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data

Used together with date of admission for calculation of age.


Data Element / Data SetEpisode of admitted patient care—admission date, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data

Used together with date of birth for calculation of age

 


Data Element / Data SetEpisode of care—principal diagnosis, code (ICD-10-AM 8th edn) ANN{.N[N]}
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Disaggregation:Help on this term

Current period (2011–14) by:

  • Indigenous status
  • Indigenous status, sex and age group (18–34, 35–44, 45–54, 55–64, 65+)
  • Indigenous status and remoteness area
  • Indigenous status and state/territory.

Time series (2004–05 to 2013–14), New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined:

  • by Indigenous status.
Disaggregation data elements:Help on this term
Data Element / Data SetPerson—area of usual residence, statistical area level 2 (SA2) code (ASGS 2011) N(9)
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient palliative care NMDS 2013-14
Guide for use

Used for disaggregation by remoteness area and state/territory.

Data source type: Administrative by-product data


Data Element / Data SetPerson—date of birth, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Used together with date of admission for calculation of age.

Data source type: Administrative by-product data


Data Element / Data SetEpisode of admitted patient care—admission date, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Data Element / Data SetPerson—Indigenous status, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetPerson—sex, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Comments:Help on this term

General:

The data for this measure are drawn from the Australian Institute of Health and Welfare (AIHW) NHMD. For 2016 reporting, the most recent data available are for 2013–14. With the exception of time trends, data are reported for the 3-year period 2011–14 to enable disaggregation of the data by the variables of interest. Single-year data are reported for the time trend analysis. People aged under 18 were excluded from all analyses due to small numbers.

Indigenous identification:

While there is some under-identification of Indigenous Australians in the NHMD, data for all states and territories are considered to have adequate Indigenous identification from 2010–11 onwards (AIHW 2013).

Time series comparisons are based on data for the 6 jurisdictions that were assessed by the AIHW as having adequate identification of Indigenous hospitalisations from 2004–05 onwards—namely, New South Wales, Victoria, Queensland, Western Australia, South Australia and public hospitals in the Northern Territory (AIHW 2010). About 95% of the Australian Indigenous population live in these 6 jurisdictions (AIHW 2015b).

With the exception of data from hospitals in Western Australia, hospitalisations where the person’s Indigenous status was not stated were excluded from analyses that compare Indigenous and non-Indigenous rates. For hospitals in Western Australia, records with an unknown Indigenous status are reported as non-Indigenous, so are included in the ‘non-Indigenous’ data in these analyses.

Comparisons by state/territory:

Due to differences in inter-hospital transfer rates across jurisdictions, interpreting differences in data by state and territory must be done with caution.

Estimation of hospitalised STEMI events:

Each record in the NHMD represents an episode of care. Individuals may be hospitalised multiple times in a reference year and it is not possible to group multiple records for an individual together without data linkage. To reduce the double-counting of STEMI events for people who were transferred to another hospital for further diagnosis or treatment, the analyses for the reported measure exclude hospitalisations ending in transfer to (an)other acute hospital. In this way, only the last hospitalisation for each STEMI event is generally counted.

Eligibility for reperfusion therapy:

Not all patients with STEMI are eligible for reperfusion therapy because of multiple comorbidities, including chronic kidney disease, which increase the risks associated with PCI. However, eligibility for reperfusion therapy cannot be determined from administrative data sources.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termEpisode
Format:Help on this term

N[NN].N

Data source attributes

Data sources:Help on this term
Data SourceNational Hospital Morbidity Database (NHMD)
Frequency
Annual
Quality statement
Data quality statement: National Hospital Morbidity Database 2013–14
Data custodian

Australian Institute of Health and Welfare


Accountability attributes

Reporting requirements:Help on this term

Annual reporting by the Australian Institute of Health and Welfare (AIHW 2015a, 2016).

Organisation responsible for providing data:Help on this term

Australian Institute of Health and Welfare

Further data development / collection required:Help on this term

Data development is required to fully report on the agreed measure. Data are not available to assess whether patients with STEMI presented to an emergency department within 12 hours of symptom onset, nor on whether patients are eligible for reperfusion therapy. While some data are available from the NHMD on treatment with fibrinolysis among admitted patients, those data are incomplete because information about drug treatment/pharmacotherapy received by admitted patients is not routinely recorded. Fibrinolysis is also more likely to be administered before hospital admission (for example, in an emergency department).

In addition, because individuals are not identified in the NHMD nor are associated hospitalisations able to be grouped together, it is necessary to estimate the number of hospitalised STEMI events by excluding hospitalisations ending in transfer to (an)other acute hospital. However, the validity of this method has not been established for calculating procedure rates, and has a number of limitations. For example, among those events that involved multiple hospitalisations, if a relevant procedure was provided in an earlier hospitalisation but not in the last, that STEMI will not be counted as having been treated with that procedure.

Release date:Help on this term24/11/2016

Source and reference attributes

Submitting organisation:Help on this term

Australian Institute of Health and Welfare

Origin:Help on this term

AIHW 2016. Better Cardiac Care measures for Aboriginal and Torres Strait Islander people: second national report 2016. Cat. no: IHW 169. Canberra: AIHW

Reference documents:Help on this term

ACCD (Australian Consortium for Classification Development) 2013a. The Australian Classification of Health Interventions (ACHI). 10th edn. Adelaide: Independent Hospital Pricing Authority, Lane Publishing.

ACCD 2013b. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian modification (ICD-10-AM)—Tenth Edition. Adelaide: Independent Hospital Pricing Authority, Lane Publishing.

ACSQHC (Australian Commission on Safety and Quality in Health Care) 2014. Acute coronary syndromes clinical care standard. Sydney: ACSQHC.

AIHW (Australian Institute of Health and Welfare) 2010. Indigenous identification in hospital separations data: quality report. Health services series no. 35. Cat. no. HSE 85. Canberra: AIHW.

AIHW 2013. Indigenous identification in hospital separations data: quality report. Cat. no. IHW 90. Canberra: AIHW.

AIHW 2015a. Better Cardiac Care measures for Aboriginal and Torres Strait Islander people: first national report 2015. Cat. no. IHW 156. Canberra: AIHW.

AIHW 2015b. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW.

AIHW 2016. Better Cardiac Care measures for Aboriginal and Torres Strait Islander people: second national report 2016. Cat. no: IHW 169. Canberra: AIHW.

Aroney C, Aylward P, Chew D, Huang N, Kelly A, White H et al. 2008. 2007 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the management of acute coronary syndromes 2006. Medical Journal of Australia 188:302–3.

Aroney C, Aylward P, Kelly A, Chew D & Clune E (on behalf of the Acute Coronary Syndrome Guidelines Working Group) 2006. Guidelines for the management of acute coronary syndromes 2006. Medical Journal of Australia 184:S2–9.

Chew D, Aroney C, Aylward P, Kelly A, White H, Tideman P et al. 2011. 2011 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the management of acute coronary syndromes (ACS) 2006. Heart, Lung and Circulation 20:487–502.

Relational attributes

Related metadata references:Help on this term

See also Indigenous Better Cardiac Care measure: 3.3-Hospitalised acute coronary syndrome events that included diagnostic angiography or definitive revascularisation procedures, 2016 Health, Standard 17/08/2017

See also Indigenous Better Cardiac Care measure: 3.5-Hospitalised acute myocardial infarction events that ended with death of the patient, 2016 Health, Standard 17/08/2017

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