Chris Oldfield, Naracoorte Community News

In two decades, the number of people who die of a heart attack in our region has plummeted by more than 20 percent – thanks to visiting cardiologist Philip Tideman and longtime rural GPs at Kincraig Medical Clinic. In Naracoorte alone, more than 500 people have benefited from their work.

Now Naracoorte and the SE are being recognised nationally and internationally for reducing death rates from heart attacks in country areas.

Dr Tideman has long been connected to the SE, first as a school student, then a trainee rural GP – before becoming a leading cardiologist and Integrated Cardiovascular Clinical Network SA clinical director.

Recently he reflected on the past few decades while visiting local patients and GPs he worked with.

He said during the 1960s and 70s Australia had the fourth highest death rate in the world from coronary heart disease.

“Of 100,000 adult males in country SA at that time, over 600 were dying every year, most before ever seeing a hospital. For women it was 300 per 100,000,” he said.

“Of those lucky enough to make it to hospital with a heart attack, 30 percent would die within 30 days.”

During the 1970s and early 80s, Dr Tideman recalled efforts and campaigns by the Heart Foundation and others to prevent heart disease.

Smoking, high blood pressure, high saturated fat, salt intake, high cholesterol levels, diabetes and lack of exercise were all recognised as causes of heart and vascular disease.

“But medical treatment for those suffering from heart disease was extremely slow to evolve,” Dr Tideman said. Even in the best coronary care units one in six patients never went home and most patients died within a few years.

Great revolution for heart patients

Dr Tideman said the 1980s marked the beginning of a great revolution in treating patients.

There were blood thinning and clot busting drugs for heart attacks, highly effective drugs for lowering cholesterol and “vastly better drugs for treating high blood pressure”.

There were also new drugs to limit the damage to the heart after a heart attack, allowing patients to live longer.

“Used optimally, we found that we could reduce the number of patients dying from a heart attack in the first 30 days–- from 30 in 100 in the early 1960s to a remarkable four in 100,” Dr Tideman said.

However, improvements seen from heart and vascular disease at Flinders Medical Centre in 1999, 2000 – and other large metropolitan hospitals nationally – were not reflected in the SE and rural Australia.

Tideman and GPs trail blazing work in the SE

Dr Tideman and his research team and colleagues at Flinders Medical Centre partnered with GPs at Kincraig Medical Clinic, Robe’s David Senior, highly skilled nurses and others around the SE.

The GPs were given what Dr Tideman described as “systems, tools and technologies”.

Part of that included bedside blood tests with immediate results, the ability to get help to interpret test results “and determine best treatment approaches by talking to a heart specialist 24/7”.

It also included the ability to administer “the best clot busting and other drugs to heart patients as quickly as possible when required”.

Additionally, high risk patients could be rapidly transferred to teaching hospital cardiology services in Adelaide.

SE recognised nationally and internationally

Dr Tideman said the results in closing the gap in outcomes for country people suffering heart disease “have been remarkable, and nationally and internationally recognised”.

By 2010 in country areas “we reduced deaths within the first 30 days after a heart attack by 22 per cent”.

“In less than 10 years we had closed the gap in outcomes for acute cardiac care between city and country,” Dr Tideman said.

“We have made huge gains in improving rural heart care in SA over the last 20 years.

“We lead the nation in many respects with this work that started in the SE.”

More to be done

Dr Tideman said the “very real” rural medical workforce crisis in SA “must be addressed rapidly and comprehensively by adoption of a rural generalist model of care”.

That model needed to be based on a Road to Rural Practice Report updated with recommendations of former Rural Health Commissioner, Professor Paul Worley.

“Country health in SA, however governance is configured, must become its own teaching hospital or network,” Dr Tideman said.

Training would meet the needs of “our highly productive rural population without reliance on overseas trained doctors going into the future”.

“Without an absolute commitment to a future rural generalist workforce in SA, country health in this state will be dead in the water, in its entirety,” Dr Tideman said.

Kincraig Medical Clinic senior partner Brian Norcock praised the work of Dr Tideman and the region’s GPs, and now visiting cardiologist Dr Andrew Markwick.

“Reducing the number of people dying from heart attacks by 20 percent in 20 years, I think is pretty good,” Dr Norcock said.

But he hoped to improve those statistics even further.

Preventing further deaths

“Historically each year around three people drop dead in the SE and many more die from a heart attack,” Dr Norcock said.

“Sometimes in hindsight using traditional risk assessment tools, they were obviously at risk, other times borderline, and on occasion so-called low risk.”

Dr Norcock urged people to have a GP check-up, and consider a CT coronary calcium scan to help predict the likelihood of a heart attack within the next five years.

He said statins were also part of the solution for reduced heart attacks.

“Statins and stents are very effective treatments – providing you get a chance, or second chance,” Dr Norcock said.

“Eighty per cent of people get through their cardiac event relatively unscathed.

“But 20 per cent don’t do well. They die or become cardiac cripples due to destroying a significant amount of their myocardium/heart muscle at the time of the heart attack.

“If you are already on a statin, for example Lipitor or Crestor, or had a cardiac event – you probably don’t need this test as you have been identified and are on very effective treatment.

“It (the test) is really useful if you have borderline risk factors – cholesterol, hypertension, smoker or ex-smoker, diabetic, family history of heart diseases especially at an early age, or are 50-65 years old and not on preventive medication.”

Dr Norcock said CT Calcium scoring took less than an hour, “is usually less than $300 and not covered by Medicare”.

“If significantly at increased risk a virtual CT angiogram may be ordered which takes up to two hours and costs around $700,” he said.

“This is a new frontier for the cardiologists and generating a lot of discussion and different points of view.

“However, in Naracoorte we’ve been doing this for some 20 years and have a series of over 200 patients that have benefited from this (CT scans alone).

“Critics say it is not as 100 per cent accurate as an actual angiogram.”

But Dr Norcock explained the significant risks – there was one in 300 chance of a major complication from an invasive angiogram, and “an exercise ECG can have up to five percent negative/false positives,” he said.

“So, this (CT scan) test will determine literally in black and white your risk if unknown.

“That is low, medium and high risk and it will enable prevention of heart attacks in those at risk, and reduce further premature death and suffering.”

This article appeared in the Naracoorte Community News.