Even after all these years is male bias still affecting women's chances of surviving heart disease?

It has been known for many years that there are differences in how symptoms of heart disease present in male and female patients, yet it appears that this knowledge is still not translating into better health management practices when assessing and treating women with cardiovascular disease and heart failure.

Excerpts from Australian Catholic University, Mary MacKillop Institute for Health Research, Hidden Hearts: Cardiovascular Risk and Disease in Australian Women, September 2016:

* Executive summary/Key findings

In the absence of a true appreciation of the burden and impact of cardiovascular disease (CVD) among Australian women, coupled with a lack of consistent, Australia-wide data, we compiled this report. Using the best available information, we reveal a number of key figures that should concern all Australians:

The five most common forms of CVD are highly prevalent in Australian women aged 35 years and over with 410,000, 177,000 and 162,000 affected by coronary artery disease (CAD), the form of heart failure (HF) most commonly linked to CAD and atrial fibrillation (AF), respectively.

An additional minimum of 90,000 and 30,000 women are hospitalised due to stroke and peripheral artery disease (PAD), each year. In 2016, 21,000, 14,000, 19,000, 12,000 and 3,000 Australian women will have suffered their first hospital admissions with CAD, HF, AF, stroke and PAD, respectively – see Figure 1.

Tragically, approximately 3,400 Australian women each year will suffer a sudden and fatal cardiac event without ever reaching hospital. Every year, these five conditions provoke a minimum of 260,000 (CAD), 73,000 (HF), 122,000 (AF), 90,000 (stroke) and 30,000 (PAD) hospital admissions among Australian women – see Figure 1.

Even with hospital treatment all forms of CVD are deadly and disabling with one in nine (2,200) women admitted for the first time with CAD dead within 28-days, and more than one third admitted for the first time with HF or stroke dead within 12 months.

The annual estimated cost of hospital care for the most common forms of CVD among Australian women alone is more than $3 billion. Within an ageing population in whom levels of most risk factors are at historically high levels, the burden of CVD among Australian women is set to increase for the foreseeable future.

There is still much to be learned in best preventing and treating CVD in Australian women; particularly in vulnerable individuals/communities.

*

* It is well recognised that the natural history and profile of women with CVD are typically different from their male counterparts.

Current management guidelines reflect a male bias due to the poor representation of women in clinical trials of new therapies.

Women are more likely to display dose-related adverse drug events from CVD pharmacotherapies due to smaller body size, higher body fat, different

metabolism and more kidney dysfunction.

Disparity also exists in cardiac rehabilitation with women failing to attend more often than men in addition to clinicians tending to refer men more frequently.

* Evidence-based management for most forms of CVD are based on clinical trials that have a higher proportion of younger men and/or less complex cases.

* CVD disproportionately affects the Indigenous peoples of Australian and in particular Indigenous women who develop and die from CVD at a much younger age.

* CVD represents an enormous health issue for Australian women. It requires a dedicated response, from the community to governments to minimise already high rates of highly preventable cardiovascular events.

Women living in the Northern Rivers region should note that in 2010-2011, the leading cause of death in the Northern NSW Local Health District  was circulatory disease (which includes cardiovascular disease), which was significantly higher than for all NSW - 193/100,000 compared to 167/100,000 according to the December 2015 health fact sheet produced by the NSW North Coast Public Health Unit.

Federal Election 2016: don't have a heart attack on Fridays

Live in a small coastal village or larger town on the NSW Far North Coast or on a Northern Rivers farm 100 km inland from the sea?

Then you have been living this situation for years.

The Northern Star, online editorial, 30 April 2016:

We live in two of the most marginal seats in Australia in the upcoming federal election and that puts us in the box seat as voters.

Our vote is crucial, what ever way you look at it.

If the Coalition wants to hang on to power it wouldn't want to lose Page, while Richmond is held by Labor's Justine Elliot by a margin of just 1%.

The past two state elections in Queensland and NSW have shown voters are swinging wildly and any form of comfortable political loyalty has flown out the window.

To be completely mercenary about it, neither major party can afford to take the people of the Northern Rivers for granted.

We live in a wonderful part of the world, that's why we are all here. But it's time for voters to rise up and demand the same sort of lifestyle someone living in the city can expect.

That's what our current Fair Go campaign is all about - closing the gap between city and country.

Health figures we've highlighted today paint a stark contrast…..

It suggests to me that our fair share of programs and support services in suicide and cancer are aimed at the wrong part of the country.

And we should demand to know from every candidate standing in Page and Richmond, what they are going to do about it?

The Daily Examiner, online, 30 April 2016, p. 1:

If you're going to collapse from a heart attack in the Clarence Valley, don't do it on a Friday says local doctor Allan Tyson.

Dr Tyson, who is a specialist anaesthetist and emergency doctor at Grafton Base Hospital, said having a heart attack on Friday was not a wise move because the cardiac unit at Coffs Harbour was only available three days a week and Friday was not one of those days.

"The standard of treatment you would get here is a standard lower than you would get if you lived in the metropolitan area," Dr Tyson said.

"Here they would give you blood thinners and hope that the problem didn't reappear

"If it was a real emergency you could be flown to John Flynn (on the Gold Coast) for treatment."

He said in contrast a patient in a metropolitan scenario would have access to the latest cardio services almost instantly…..

The Daily Examiner, 30 April 2016, p. 4:

Clarence Valley residents are more likely to die of avoidable diseases caused by smoking, drinking and obesity than Aussies living in capital city suburbs.

A special ARM Newsdesk analysis of public health data shows the long-term outlook for our region's residents is dire.

The Daily Examiner today reveals a set of shocking statistics as we ramp up our Fair Go for Clarence Valley campaign in the lead-up to the mooted July 2 double dissolution election.

We are calling for iron-clad federal guarantees on a range of issues including health, education and employment so we can have the same advantages and outcomes as metropolitan Australia.

An in-depth analysis of data from the Social Health Atlas of Australia reveals the following alarming health trends for our region.

At least 22.8% of Clarence Valley residents smoke compared to 14.5% in the region's closest capital city, Brisbane.

About 5.4% of our residents drink alcohol to excess. This figure is higher than Brisbane on 4.9%.

Almost one third of the Clarence Valley population is obese. At 31.9%, our obesity rate is higher than Brisbane's 25.2%.

Our avoidable cancer death rate of 121.5 per 100,000 residents from 2009 to 2012 was significantly higher than Brisbane's 93.6.

Deaths from avoidable heart disease in the same period hit 26.9 per 100,000 people in Clarence Valley. This was higher than Brisbane's rate of 25 per 100,000 residents.

The recent Medical Research and Rural Health -- Garvan Report 2015 confirms that death rates from chronic and avoidable diseases increase the further you get from capital cities.

The Garvan Research Foundation found regional areas also had steeper rates of high blood pressure, diabetes and mental health problems.

The report reveals many reasons for the health disparities, but most of them revolve around a set of social factors that include smaller household incomes, higher risk jobs such as mining and farming, a lack of similar specialist medical services compared to metropolitan Australia and the higher cost of transporting healthy foods such as fresh fruit and vegies to our region.

"The foundation of all good policy is a solid information base and a good understanding of the realities facing any sector of the population," Garvan chief executive Andrew Giles said.

Australian Medical Association vice-president Dr Stephen Parnis agreed, saying it would take long-term commitments from successive governments to reverse the Clarence Valley's negative health trends.

Dr Parnis said the first step towards bridging the gaps was ensuring our region had the same health services as those available to capital city residents…..

The Northern Star, 30 April 2016, pp.1 & 6:

The suicide rate per 100,000 in Sydney is 5.3%. In the Northern Rivers it's 12.5% Avoidable cancer deaths per 100,000 people in the Northern Rivers is 103.7. In Sydney it's 95.1…..

"I need to keep across the readings. But as a pensioner I won't be able to afford the 29 tests per year."

Pathology companies are threatening to introduce a $30 co-payment for all medical tests, including pap smears, MRIs and blood tests, if the government goes ahead with the cut.

Mr McPherson's cluster headaches -- much more significant than migraines -- usually take 10 to 12 years to diagnose.

"The lithium reduces the pressure in the nerves. I will need lithium monitoring for the rest of my life," he said.

"I'm about to go on my second program of lithium which is only used in extreme cases of this condition.

"Everything I do has to be inside because light is a trigger for this condition."

"When I saw the Federal Government had made a decision to stop bulk billing of blood tests and pap tests and MRIs, I realised the situation was going to be quite awkward on a pension," he said.

This week doctors at 5500 private collection centres began approaching their patients to sign a petition asking the Senate to block the cuts.

However, according to a new report from the Grattan Institute, taxpayers could save over $240 million a year if the government made pathology companies tender to provide testing services. According to the report, pathology companies now benefit from cheaper, automated testing.

Far from calling for an exemption for his specific case, Mr McPherson has instead called the cuts a war on women.

"Women will die because they will not get regular pap smears which can detect and prevent cancer. It's false economy," he said.

"At cabinet level, did they have a document, which explored the impact of this policy in term of rates of mortality for women?

"And did they say we can accept that?

"Someone has made a decision here, without thinking of the broader impact of the community."

News Mail, 30 April 2016:

Getting good doctors to commit to the bush long-term is a huge struggle so two of the country's key health lobby groups have prescribed a simple remedy - more money.

The Rural Doctors Association of Australia and the Australia Medical Association say there is room in the multi-million dollar Commonwealth-funded Service Incentive Payment program to apply higher remoteness loadings for GPs happy to relocate from the city.

In releasing the RDAA and AMA's Rural Rescue Package, Dr Ewen McPhee said extra financial support aimed at "revitalising and sustaining" rural medical services could be the key to closing health gaps.

The RDAA president said financial incentives based on the remoteness of the area in which GPs worked was the way to go.

"Over the past two decades, many rural and remote communities have found it increasingly difficult to attract and retain doctors with the right mix of skills to meet their health and medical needs, including GPs with advanced skills training who can provide acute services in the hospital setting," Dr McPhee said.

"The Rural Rescue Package would make a huge difference."

The Daily Examiner, 30 April 2016, p. 5:

Maclean Hospital has a constant wish-list of equipment that government cannot fund, so a dedicated group of women and men take it on themselves to do something about it.

The Maclean Hospital Auxiliary have been raising money for the past 70 years and in the past year have raised about $75,000 for the hospital.

Add this to another $107,000 of equipment on order, and that's a lot of cakes and biscuits being sold at stalls.

"They give us a wish list, the articles they need, and then we go down through the list and supply them with whatever monies we have at the time," president Sandra Bradbury said.

"We do various fundraisers, we have four stalls a year, street stalls and we bake cakes."

Without the help of donations, Mrs Bradbury said the hospital would not be nearly as well off.

"It used to be a full running hospital and now it's not... years ago it used to have a children's ward and a birthing place," she said.

The Daily Examiner, online, 29 April 2016:

This is a tale of two babies.

They were born 600km apart, but statistics suggest their prospects are worlds apart.

Data shows Clarence Valley newborn Charlotte Billett, pictured above with parents Stacey and Jeremy, is at risk of dying 4.9 years earlier than Sophia Milosevic, pictured right with her mum Kate.

For both children, their distance from capital cities makes all the difference.

Sophia's home is in the Federal seat of Bennelong in the north of Sydney, a seat long held by former prime minister John Howard.

Charlotte was born in Grafton, 310km from Brisbane and 890km from Canberra.

A special Daily Examiner investigation reveals how regional Australia has been let down, with health, education and infrastructure funding failing to help those who need it most.

In Grafton, the life expectancy for a baby born in 2014 is 80.4 compared to 85.3 where three-month-old Sophia lives in the Sydney suburb of Ryde.

Australian Bureau of Statistics figures reveal the median age of death for locals is 80 compared to 84 in the Ryde council area…..

Public health policy expert Dr Rob Moodie said Grafton's life expectancy rates and median age of death would not improve until the Clarence Valley matched its metropolitan cousins on income, education, employment and access to more top-quality health services…..

The Norther Star, 28 April 2016, p.6:

Over 420,000 Australians have banded together to back up pathology centres in their fight against cuts to bulk billing incentive payments.

Local collection centres advertised their Don't Kill Bulk Bill petition for patients to sign and health centres to get on board.

Natarsha Wotherspoon of Lismore chemist, Blooms, wanted to help.

"It's hard to come up with money for all your health needs ... How many people can't afford to eat, let alone pay for a blood test?" She said.

"If you're very ill and you're getting blood tests two or three times a week, the last thing you need to be thinking about is how you are going to pay for all these tests."

Ms Wotherspoon and the other chemist staff collectively gathered over 2000 signatures.

The Turnbull Government announced on December 17 it would scrap payments to pathologists and diagnostic imaging services when they bulk billed patients, saving $650 million over four years.

Health Minister Sussan Ley said the sector could absorb the losses, but pathologists disagreed.

President of Pathology Australia Nick Musgrave said pathologists would have to charge patients a co-payment…..

The Northern Star, 23 April 2016, p.8:

They were born 730km apart, but statistics suggest their prospects are worlds apart.

Data shows Frankie Lindsay is at risk of dying four years earlier than Sophia Milosevic, pictured right with her mum Kate.

For both children their distance from capital cities makes all the difference.

Sophia's home is in the Federal seat of Bennelong in the north of Sydney, a seat long held by former prime minister John Howard.

Frankie was born in Casino, 195km from Brisbane and 1000km from Canberra.

A special Northern Star investigation reveals how regional Australia has been let down, with health, education and infrastructure funding failing to help those who need it most.

In Lismore, the life expectancy for a baby born in 2014 is 81.2 years compar- ed with 85.3 where three- month-old Sophia lives in the Sydney suburb of Ryde…..

Meanwhile, Ms Milosevic said there was no better place to raise a child in Australia than Ryde.

"It is a Liberal seat so it seems to do very well for itself," she said.

"There are constantly things happening, new playgrounds and projects with new funding.

"It's brought a different demographic of people and the area has become quite affluent."…..

The Northern Star, editorial, 23 April 2016, p.9:

…..Prime Minister Malcolm Turnbull will take the country to the polls within months.

Getting a Fair Go for our region will be our priority through the election campaign.

Mr Turnbull and Bill Shorten have questions to answer. Their parties must prove we are a priority.

Our sister papers across Queensland and northern New South Wales - and those of NewsCorp - will fight for the same thing.

Together, we represent the more than 6 million Australians who don't live in the big cities. Combined we reach 3.3 million readers a month.

Politicians beware: That's a lot of voters.

One in three Australians live in the regions - and they deserve the same access to health care, education, and employment prospects as those in our capital cities.

They're not getting it now, and that has to end.

Living in the bush, or at the beach, should not be a life sentence.

Little Frankie deserves better.

In his 2017-17 Budget speech last night Treasurer Scott Morrision announced an estimated additional $2.9 billion over three years for public hospital services.

With this sum having to be cut seven ways between the states and territories, I think one may safely say that Far North Coast health services will continue to lag behind those in the metropolitan areas across Australia and our life expectancy and health outcomes will continue to be lower under this federal government.

Deaths from major trauma in NSW trauma centres have declined since 2003 - but you're still more likely to die in regional NSW

Deaths from major trauma in NSW trauma centres have declined since 2003, and definitive care at a Level 1 trauma centre was associated with a survival benefit according to a recent article in The Medical Journal of Australia.

Level 1 trauma centres are confined to large metropolitan centres. On the NSW North Coast in 2009 there were 'adult patient' regional trauma centres listed at Coffs Harbour Base Hospital, Lismore Base Hospital and The Tweed Hospital. These appear to remain the only trauma centres in the region.

During the period studied the number of interhospital transfers between regional trauma centres and Level I centres did not increase significantly despite such transfers being shown to potentially halve the mortality rate.

Because of the systematic neglect of regional NSW by successive state governments and across the board cuts to public service delivery by the current O’Farrell Coalition Government, this is the risk North Coast residents are exposed to if they are involved in a serious motor vehicle/work/sports/in home accident:

Regional trauma centres play an important role in the delivery of trauma care, but often lack specialty resources. Most are located outside Sydney, and road travel time from regional trauma centres to a Level I centre ranges from 30 minutes to 2 hours. In a recent single region study in NSW, morbidity was significantly higher in a regional trauma centre compared with a Level I centre.10……..

Patients admitted to a regional trauma centre had a significantly higher mortality rate compared with those admitted to a Level I centre. The survival benefit at Level I centres could be explained by the presence of greater resources, such as the availability of surgically trained staff 24 hours a day, a multidisciplinary trauma service14,15 and higher patient volumes, resulting in enhanced expertise in trauma care.16 Deficiencies in trauma care, regardless of trauma centre level, may occur at multiple points of care and are more likely to occur when there is failure to comply with protocols, poor communication and/or delayed referral.10,14,17,18 However, without reviewing each of the deaths in this study, it is not possible to comment on factors contributing to mortality.

The benefits of primary transport or early interhospital transfer of patients with major trauma to a Level I trauma centre are confirmed in our study. In 2008 Ambulance NSW introduced “Protocol T1”, which specifies that patients with major trauma should be taken directly to a Level I centre, bypassing lower-level centres, if transport time is within 1 hour.19 The impact of Protocol T1 on patient transport practice and outcomes requires evaluation.

The geography of NSW means that regional trauma centres will continue to play an important role in initial stabilisation of patients with trauma. Our study suggests that improved adherence to transfer guidelines will contribute to improved patient outcomes consistent with the experience in Victoria17 and the United States.20 In recent years, a series of standardised transfer guidelines for patients with major trauma have been implemented in NSW, with variable compliance.10,21 The low numbers of transferred patients could also result from some patients with critical injuries being deemed too unstable for transfer, transfer being considered futile, or patients dying before a transfer decision was made.10,21

Initial trauma response and hospital transfers in regional areas are under pressure as the Ambulance Service of NSW is being asked to respond to increased demand with existing staff numbers.

Trauma services are one aspect of the true cost to local communities and local families of public service job cuts currently underway in the Clarence Valley and elsewhere and, why the almost cavalier attitude of North Coast Nationals MPs to these cuts is unacceptable and offensive.

One of the reasons why the North Coast Area Health Service continues to be given a FAIL

Sometimes it almost beggars belief what the NSW Government, NSW Dept of Health, the North Coast Area Health Service and its CEO Chris Crawford consider priorities in a region where public health services continue to fail to meet community need.

Target budget cuts of $300M, undertake a three-wave reduction of 400 health care positions from directors of nursing right down to ward staff. Even sack a hospital chaplain. Because the Northern Rivers doesn't need medical services - it needs an expensive spin doctor!

This position advertisement is up on the NSW Dept of Health website:

Caring Together Liaison Officer
Name of Facility Lismore Health Campus
Position Number 0433/09
Basis Permanent Full Time
Salary $88,048-$100,375
Closing Date 27 November, 2009
Purpose of Role:
This position reports to the Chief Executive and is responsible for the effective coordination of the implementation of the NSW Health Caring Together, Health Action Plan recommendations incorporating the management of Area-wide media liaison. This will include coordinating media strategies and media responses with NSW Health Communications and the Office of the NSW Health Minister, and the preparation of publications, media releases and editorial contributions, including photographs, and briefings about media issues relating to the activities of NCAHS, in particular, the ongoing implementation of the NSW Health Caring Together Health Action Plan.

The Daily Examiner 4 December 2009

Northern Star 3 December 2009 $100,000 job offer a PR disaster

And to think that some people think he's premier material. They have to be joking.

NSW Minister for Health John Della Bosca just doesn't get it.

Della Bosca visited Lismore on Thursday and announced 11 new positions for the North Coast Area Health Service (NCAHS). Yes, that's right, e-l-e-v-e-n, 11 positions. No, he hasn't been misreported.

What a hide the bloke has! He has more hide than Jessie the elephant.

Sorry, John, but northern NSW doesn't need any more sick attempts at comedy by persons supposedly responsible for at least maintaining if not improving public health services in that neck of the woods.

Only nine months ago, and under the stewardship of the NSW Ministry of Health, the NCAHS embarked on a program to slash 400 full time equivalent positions from the region's health services.

Ironically, NSW Health has just released a media statement titled Caring Together for Lismore Base Hospital to announce that recruitment is under way for the clinical support officers and pharmacists at Lismore Base Hospital.

And who is the Health Department's first lieutenant on the ground in northern NSW? It's none other than Chris Crawford (pictured below).


Crawford, NCAHS's CEO, has wielded a big stick as he has gone about the demolition job that's being done on local health services. Truly, listening to the bloke on local radio as he goes about attempting to defend the cuts to health services is enough to make you sick.

And where is the NSW Opposition? What does it have to say about what's going on in relation to this sorry saga involving north coast health services?

Sadly, the Opposition is AWOL - there's not a bleep on the radar to indicate that lot is in tune with public sentiment that's running red-hot on this important issue.

It's not as if the Opposition isn't at least faintly aware of the fiasco. One of its front benchers probably hears a bit about it over the breakfast table.

The shadow minister for climate change and environmental sustainability, Catherine Cusack (pictured below), is married to Crawford.

Perhaps Ms Cusack and the current shadow minister for health Jillian Skinner should swap jobs.