Cardiac aria: A geographic approach to measure accessibility to cardiac services in Australia before and after an acute cardiac event

Background/Aims: Access to appropriate care for an acute cardiac event is critical for positive outcomes. Most lives are saved within the first hour. The aim of the Cardiac ARIA index was to derive an objective, comparable, geographic measure reflecting access to cardiac services across Australia. Methods: An expert panel defined a cardiac event and a single patient care pathway. Using geographic information systems (GIS) the index was modelled in two phases. The acute phase measured the time from ‘000’ to arrival at an appropriate medical facility via ambulance/road and an aftercare phase (return to community) measured the availability of four basic services (doctor, pharmacy, cardiac rehabilitation, and pathology). Results: The acute phase of the index ranges from 1 (access to tertiary centre with PCI = 1 h) to 8 (no ambulance service, >3 h to medical facility, air transport required). The aftercare phase was modelled into five alphabetic categories, A (all four services = 1 h) to E (no services available within 1 h). Approximately 13 million (66%) Australians live within Cardiac ARIA Category 1A locations (i.e. a hospital with ICU/CCU and cardiac catheter laboratory and all aftercare = 1 h). 6.7 million (34%) live outside of this range. Conclusion: The Cardiac ARIA index indicates that ‘Geographically’ the majority of Australian's are located in communities that have timely access for survival. Therefore, it appears that it is how quickly systems mobilize (response time), rather than distance, that will affect the outcomes of a cardiac event.