Overview

Project status: Completed

Disclaimer: All data presented in this report is accurate based on the data that was available and accessible to this project at the time of development and completion of the index [February 2009 - 2010].

In an acute cardiac event access to timely and definitive care via specialist centres is critical to survival and improving longer-term outcomes. Similarly, for survivors, ready access to more routine health care, including specialist management (via a cardiologist and cardiac rehabilitation program) and community-based primary care are essential in preventing potentially fatal secondary events.

While evidence-based guidelines provide advice on managing a cardiac event in ideal circumstance, in reality their implementation is often limited by: a) the geographic location of the initial acute event and b) the location and level of facilities available to manage that event in a timely manner. For example, only an estimated 20% of emergency departments in the USA are located in hospitals with a cardiac catheterisation laboratory. Still fewer have the capability to perform immediate revascularisation.

These data reinforce the importance of ready access to more portable and potentially life-saving therapies such as defibrillators and thrombolytic therapy, as well as efficient cardiac triage and transportation.

The Cardiac Accessibility and Remoteness Index of Australia (Cardiac ARIA) measured access to cardiac care through a 'geographic lens' via an objective, comparable measure of the time and distance from any population location to evidence-based cardiac care. An index of access to health services independent of professional, socio-economic or political influences was generated. It highlighted substantial inequities in access to cardiac services in Australia. Cardiac ARIA represents a powerful and adaptable tool to optimise outcomes by informing more equitable distribution of cost-effective, life-saving health care in any given geographic location.

Cardiac ARIA Report and Index

Read details

Grantor

This project was funded by an Australian Research Council Linkage Grant LP0775217_Clark with Linkage partner AlphaPharm Pty Ltd.

Associate Professor Robyn A Clark is funded by a Post-Doctoral Research Fellowship supported by the NHMRC (NHMRC Grant ID 570 141).

Professor Simon Stewart is Senior Research Fellow supported by the NHMRC (NHMRC Grant ID 472 658).

Amount
  • $158,688 (2007-2009)
Research leader
External collaborators

Research team

  • A/Prof Robyn Clark, CI-A, Project Manager, Conception of project
  • Prof Andrew Tonkin, CI-B
  • Prof David Wilkinson, CI-C
  • Dr Kerena Eckert, CI-D
  • Mr Neil Coffee, CI-E, Project Manager, GIS
  • Ms Tricia Smail, PI-1
  • Prof Simon Stewart, PI-2
  • Ms Deborah van Gaans, ARC APAI-PhD
  • Dr Dorothy Turner, Post Doctoral Research Associate

Collaborators

  • Ms Louise Moylan, Post Doctoral Research Assistant
  • Mr Errol Bamford, Conception of project
  • Mr David Coombe, GIS Consultant
  • Prof Graeme Hugo, ARC APAI-PhD Supervisor
  • Dr Kym Nicholson, ARC APAI-PhD Supervisor
  • Ms Maria Fugaro, Finance Manager
  • Mr Chris Moyan, Finance Manager
  • Prof Mark Daniel, Post Doctoral Mentor (A/Prof Robyn Clark)
  • Prof Kerin O'Dea, Post Doctoral Mentor (A/Prof Robyn Clark)
  • Prof Esther May, Post Doctoral Mentor (A/Prof Robyn Clark)
  • A/Prof Annette Raynor, Post Doctoral Mentor (A/Prof Robyn Clark)
  • Prof Patsy Yates, Post Doctoral Mentor (A/Prof Robyn Clark)
  • Mr Peter Astles, Industry Partner
  • Ms Marian Milligan, Industry Partner
  • Mr Greg Pearce, Industry Partner
  • Mr Justin Lawrence, Industry Partner
  • Ms Jacqui Howard, Co-ordinator of ARC submission (2006)
  • Ms Carmel Sutcliff, Postgraduate Research Assistant
Organisational unit
Lead unit Faculty of Health Other units
Start date
15th August 2007
End date
15th August 2010
Research areas
Keywords
cardiac GIS, accessibility index, aria, rural health, geographic modelling, cardiac rehabilitation, acute cardiac care, emergency cardiac care

Contact

For more information contact Associate Professor Robyn Clark.
 

Details

Background

Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services in Australia.

Methods

An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), a numeric/alpha index was developed at two points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alpha) measured access to four basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) for when a patient returned to their community.

Results

The numeric index ranged from 1 (access to principle referral center with cardiac catheterisation service ≤ 1 hour) to 8 (no ambulance service, > 3 hours to medical facility, air transport required). The alpha index ranged from A (all 4 services available within 1 hour drive-time) to E (no services available within 1 hour). 13.9 million (71%) Australians resided within Cardiac ARIA 1A locations (hospital with cardiac catheterisation laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were over-represented by people over 65 years (32%) and Indigenous people (60%).

Conclusion

The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and the methodology could be applied to other common disease states within other regions of the world.

Clinical trial registration

Not applicable

Partnerships

ARC logo
Australian Research Council

University of South Australia
University of South Australia

The University of Adelaide
The University of Adelaide

Alphapharm logo
Alphapharm

GISCA
The National Centre for Social Applications
of Geographic Information Systems

Monash University logo
Monash University

The University of Queensland
The University of Queensland

Baker IDI logo
Baker IDI

Heart Foundation logo
Heart Foundation

Pitney Bowes logo
Pitney Bowes

Tonkin logo
Tonkin Consulting

Acknowlegements

This project was funded by an Australian Research Council Linkage Grant LP0775217 with Linkage partner Alphapharm Pty Ltd. We acknowledge Errol Bamford for the original conceptualisation of the index and Mr Peter Astles, a passionate advocate who is acknowledged for establishing the partnership for the linkage funding. Robyn Clark and Simon Stewart are funded by the National Health and Medical Research Council of Australia.

We wish to especially thank David McDonald, Spatial Information Manager, Tonkin Consulting, Nigel Lester, Channel Sales Manager Australia & New Zealand, Pitney Bowes Business Insight, and Paul Parsons, Dave Ng, Channel Sales Executive Australia & New Zealand, Pitney Bowes Business Insight for supporting the project by providing strategic datasets such as Tonkin Street Pro.

The project acknowledges the contribution to Cardiac ARIA from all collaborators including Prof Graeme Hugo, Ms Maria Fugaro, Carmel Sutcliff, Ms Louise Moylan, Mr Chris Moyan, Prof Mark Daniel, Prof Kerin O'Dea, Prof Esther May, A/Prof Annette Raynor, Ms Marian Milligan, Mr. Greg Pearce, Mr. Justin Lawrence, Ms Tricia Smail, Ms Jacqui Howard, The Heart Foundation (Australia) and our expert panelists: Professor Derek Chew, Professor Hugh Grantham, Professor Peter Mc Donald, Professor Andrew Mac Isaac, Professor Peter Thompson, Professor Warren Walsh, Professor Phil Tideman, Rosy Tirimacco, Wendy Keech and Vanessa Poulsen, Associate Professor Matt Hooper.

Publications and output

Peer reviewed research reports

Clark RA, Coffee N, Turner D, Eckert K, van Gaans D, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Application of geographic modeling techniques to quantify spatial access to health services before and after an acute cardiac event: The Cardiac ARIA project. (Accepted Circulation  2012 March 12th )

Coffee N, Turner D, Clark RA, Eckert K, Coombe D, Hugo D, van Gaans D, Wilkinson D, Stewart S, Tonkin A. On behalf of the Cardiac ARIA project. Measuring National Accessibility to Cardiac Services Using Geographic Information Systems.  Journal of Applied Geography 2012; 34:445-455.

Ranasinghe I, Turnbull F, Tonkin A, Clark RA, Coffee N, Brieger D. Comparative Effectiveness of Population Interventions to Improve Access to Reperfusion for ST-Segment-Elevation Myocardial Infarction in Australia. Circulation: Cardiovascular Quality and Outcomes. (In Press) 2012.

Clark RA., Coffee N. On Behalf of the Cardiac ARIA project. Why measuring accessibility is important for public health: a review from the Cardiac ARIA project. Public Health Bulletin SA Rural Health in the 21st century: Challenges and opportunities. 2011 March; 8 (1):3-8.

Clark RA, Coffee N. Turner D, Eckert K, Stewart S, Wilkinson D, Tonkin A On behalf of the Cardiac ARIA project. Access to cardiac rehabilitation does not equate to attendance. European Journal of Cardiovascular Nursing (Submitted March 2012).

Report

Clark RA, Coffee N, Eckert K, Turner D, Eckert K, Bamford E, van Gaans D, Astles P, Milligan M, Smail T, Stewart S, Coombe D, Sutcliff C, Wilkinson D, Tonkin A. On Behalf of the Cardiac ARIA project. Cardiac ARIA: Measuring the accessibility to cardiovascular services in rural and remote Australia via applied geographic spatial technology (GIS).

Peer reviewed published abstracts

Clark RA, Coffee N, Turner D, Eckert K, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Access to cardiac rehabilitation does not equate to attendance. Winner Nursing /Allied Health Professional Investigator Award. European Heart Journal, 2011; 32 (Abstract Supplement):159.

Clark RA, Coffee N, Turner D, Eckert K, van Gaans D, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Access to cardiac rehabilitation and secondary prevention services in Australia: Is geography really the issue? Winner Nursing Research Prize Paper, Cardiac Society of Australia and New Zealand (CSANZ) Heart Lung Circulation 2011; 20 (Suppl 2):S6.

Clark RA, Coffee N, Turner D, Eckert K, Smail T, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Can the Cardiac ARIA Index improve cardiac care for Australia's Indigenous population? Heart Lung Circulation 2011; 20(Suppl 1):S32.

Clark RA, Coffee N, Eckert K, Turner D, Tonkin A. Cardiac ARIA: A geographic approach to measure accessibility to cardiac services in Australia before and after an acute cardiac event. Australian Journal of Critical Care. February 2011; 24 (1): 60.

Clark RA, Coffee N, Eckert K, Turner D, Coombe D, Lawrence J, Stewart S, van Gaans D, Wilkinson D, Tonkin A, On behalf of the Cardiac-ARIA project. Where not to have a heart attack in Australia!: The Cardiac ARIA index. Heart Lung Circulation, 2010; 19 (Suppl 2):S159.

Coffee N, Clark RA, Eckert K, Turner D, Coombe D, Lawrence J, Stewart S, van Gaans D, Wilkinson D, Tonkin A, On behalf of the Cardiac-ARIA project. Cardiac ARIA: Population Accessibility to 24 hour/7 Day Public Catheterization Laboratories. Heart Lung Circulation, 2010; 19 (Suppl 2):S122.

Clark RA, Wilkinson D, Coffee N, Eckert K, Astles P, Milligan M, Pearce G, Stewart S, van Gaans D, Turner D, Coombe D, Aroney C, Chew D, Grantham H, MacDonald P, MacIsaac A, Thompson P, Walsh W, Tonkin A, On behalf of the CARDIAC-ARIA project group. Mapping services to support a patient's journey through evidence-based care pathways after a cardiac event. Heart Lung and Circulation 2009; Vol. 18 Suppl. 3: S266.

Clark RA, Tonkin A, Wilkinson D, Coffee N, Eckert K, Milligan M, Astles P, Stewart S, On Behalf of the cardiac ARIA Project Team. CARDIAC-ARIA: Measuring the accessibility to cardiovascular services in rural and remote Australia via applied geographical spatial technology (GIS) Heart Lung and Circulation 2008; Vol. 17 Suppl 3:S23.

Presentations

Clark RA, Coffee N, Turner D, Eckert K, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project Access to cardiac rehabilitation does not equate to attendance. Winner Nursing /Allied Health Professional Investigator Award, European Society of Cardiology Paris France August 27-31 August 2011.

Clark RA, Coffee N, Turner D, Eckert K, van Gaans D, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Access to cardiac rehabilitation and secondary prevention services in Australia: Is geography really the issue? Winner Nursing Research Prize Paper, Cardiac Society of Australia and New Zealand (CSANZ) Perth August 11-14th 2011.

Clark RA, Coffee N, Turner D, Eckert K, van Gaans D, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Access to cardiac rehabilitation and secondary prevention services in Australia: Is geography really the issue? Oral Presentation Australian Cardiac Rehabilitation Association (ACRA) Perth 8-10th August 2011.

Coffee N, Clark RA, Turner D, Eckert K, Stewart S, Bamford E, van Gaans D, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project Cardiac ARIA: Using GIS to measure the national access to cardiac catheter laboratories. Oral Presentation, IAG Conference Wollongong September 2011.

Clark RA. 'Can the Cardiac ARIA Index improve cardiac care for Australia's Indigenous population?' The Cardiac Society of Australia and New Zealand 2nd Indigenous Cardiovascular Health Conference Alice Springs June 17-19th 2011.

Coffee N, Clark RA, Turner D, Eckert K, Snail P, Stewart S, Bamford E, van Gaans D, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project Cardiac ARIA: Measuring the nations access to PCI. Poster Presentation, The Australian National Heart Foundation 2011 Conference a biannual showcase of Australian Cardiac Research. Melbourne Convention Centre, March 17-19th 2011.

Clark RA. 'Cardiac Aria: A Geographic Approach to Measuring Accessibility to Cardiac Service Before and After an Acute Cardiac Event'. The Australian National Heart Foundation 2011 Conference a biannual showcase of Australian Cardiac Research. Presentation Type: Invited Speaker. Melbourne Convention Centre, March 17-19th 2011.

van Gaans D, Hugo G, Tonkin A, Biggins J, Higgins R., On Behalf of the Cardiac ARIA project. Spatial Modelling of Accessibility to Phase 2 Cardiac Rehabilitation in Australia. Poster Presentation Australian Cardiovascular Health and Rehabilitation Association (ACRA), 12-141h August 2010, Canberra Australia.

Turner D, Coffee N, Clark RA, Eckert K, Coombe D, Lawrence J, Astles P, Stewart S, van Gaans D, Hugo G, Bamford E, Wilkinson D, Tonkin A, On Behalf of the Cardiac-ARIA project. Cardiac ARIA: A Geographic Accessibility Model to Cardiac Services in Australia. Proceedings: Spatial Information Committee (SICOM), Surveying and Spatial Sciences Institute (SSSI) and Spatial industries Business Association (SIBA) Spatial Information Day, Adelaide Convention Centre, Friday 13th August 2010.

Clark RA, Tonkin A, Wilkinson D, Eckert K, Coffee N, Astles P, Milligan M, vanGaans D, Stewart S. On Behalf of the Cardiac ARIA Project. Where not to have a heart attack in Australia: The CARDIAC-ARIA project. Invited Plenary Speaker Heart Foundation, Heart Week Health Professional Forum May 7th 2010, Art Gallery of South Australia.

Clark RA, Tonkin A, Wilkinson D, Eckert K, Coffee N, Astles P, Milligan M, van Gaans D, Stewart S. On Behalf of the Cardiac ARIA Project Team. Cardiac-ARIA: Measuring the accessibility to cardiovascular services in rural and remote Australia via applied geographical spatial technology (GIS). Invited Speaker. Proceedings Heart Foundation Conference 2009, Hearts in focus-celebration, collaboration and challenges 14-16 May 2009, Brisbane Convention and Exhibition Centre, Australia.

Clark RA., Measuring the accessibility to cardiovascular services in rural and remote Australia via applied geographical spatial technology (GIS). Oral presentation. Australian Cardiovascular and Health Rehabilitation Association and Chronic Disease Network Joint Conference. Alice Springs Convention Centre August 13th-15th 2008.

Posters

Clark RA, Coffee N, Turner D, Eckert K, Smail T, Stewart S, Wilkinson D, Tonkin A. On behalf of the Cardiac ARIA project. Can the Cardiac ARIA Index improve cardiac care for Australia's Indigenous population? Heart Lung Circulation 2011; 20(Suppl 1):S32.

Clark RA, Coffee N, Eckert K, Turner D, Coombe D, Lawrence J, Stewart S, van Gaans D, Wilkinson D, Tonkin A, On behalf of the Cardiac-ARIA project. Where not to have a heart attack in Australia!: The Cardiac ARIA index. Heart Lung Circulation, 2010; 19 (Suppl 2):S159.

van Gaans D, Hugo G, Tonkin A, Biggins J, Higgins R., On Behalf of the Cardiac ARIA project. Spatial Modelling of Accessibility to Phase 2 Cardiac Rehabilitation in Australia. Poster Presentation Australian Cardiovascular Health and Rehabilitation Association (ACRA), 12-141h August 2010, Canberra Australia.

Clark RA, Wilkinson D, Coffee N, Eckert K, Astles P, Milligan M, Pearce G, Stewart S, van Gaans D, Turner D, Coombe D, Aroney C, Chew D, Grantham H, MacDonald P, MacIsaac A, Thompson P, Walsh W, Tonkin A, On behalf of the CARDIAC-ARIA project group. Mapping services to support a patient's journey through evidence-based care pathways after a cardiac event. Heart Lung and Circulation 2009; Vol. 18 Suppl. 3: S266.

Clark RA, Tonkin A, Wilkinson D, Coffee N, Eckert K, Milligan M, Astles P, Stewart S, On Behalf of the cardiac ARIA Project Team. CARDIAC-ARIA: Measuring the accessibility to cardiovascular services in rural and remote Australia via applied geographical spatial technology (GIS) Heart Lung and Circulation 2008; Vol. 17 Suppl 3:S23.