Monday, September 1, 2014

First Nations, Inuit people have heart attacks earlier, but fare as well in hospital

TORONTO — A new report says First Nations and Inuit people typically have heart attacks earlier in life than non-aboriginals.
And First Nations people who have heart attacks are more likely to have other conditions that raise their heart health risks, such as Type 2 diabetes.

The report says First Nations people are less likely than non-aboriginals to have some standard preventive procedures after heart attacks — things like angioplasty, which re-open blocked arteries.
But it says that they appear to do as well in hospital as non-aboriginals, with no higher rate of death within 30 days of the heart attack.
The report is from the Canadian Institutes for Health Information and is considered the first to look at aboriginal peoples and the hospital care they get after heart attacks in this country.
It is based on seven years of data, from 2004-05 to 2010-11.
In some parts of Canada, hospitals do not record the ethnicity of patients. So in fact, CIHI cannot tell precisely which patients are aboriginal and which are not.
To get around that, they use a tool Statistics Canada developed, identifying areas of the country where there are high concentrations of people of First Nations or Inuit ethnicity and compared heart attack rates from those areas to others where few aboriginal people are believed to live. That data was drawn from the 2006 census.
The resulting CIHI analysis suggests that people who live in areas of high concentrations of First Nations and Inuit people are more likely to have a first heart attack seven to 10 years earlier, respectively, than people from areas with low numbers of aboriginal people.
But people from high Inuit population areas were substantially less likely than people from non-aboriginal areas to have heart attacks at all. The rate of new heart attack events was 35 per cent lower for residents of high Inuit areas, the report says.
Sushma Mathur, manager for CIHI’s Canadian Population Health Initiative, said research has suggested the traditional Inuit diet — rich in fish — may have a protective effect against heart disease.
But she said high levels of smoking in that community, as well as rising obesity levels and a shift away from the traditional diet may lead to an increase in heart disease in this population in future.
The report found that residents of high First Nations areas were less likely to undergo treatments that mitigate the damage of heart attacks and help prevent future ones than people from areas with few aboriginals.
That probably is due to the distance people have to travel to get to a hospital that can do those kinds of procedures, said Malcolm King, scientific director of the Canadian Institutes of Health Research’s Institute of Aboriginal People’s Health.
Some of the procedures, like angioplasty, are best done within a short time of the heart attack to be successful, noted King, a professor in the faculty of health sciences at Simon Fraser University in New Westminster, B.C.
King said more needs to be done to increase the range of cardiac care services offered in remote and northern communities.
“We do need to have more development of remote treatments. You can’t put the high tech stuff all over the country, but there are some things, I think, that could be done.”
But more importantly, King said, more attention must be paid to addressing the conditions that put First Nations people at higher risk of heart attacks.
“That’s still, to me, the bottom line. If you have a population that was healthy to begin with, then a lot of these disparities wouldn’t be there,” he said.

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