{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T00:26:46Z","timestamp":1793924806445,"version":"4.8.0"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2023,8,21]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting, participants<\/jats:title><jats:p>Adults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Severity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non\u2010ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (&lt;\u200950% stenosis) underwent revascularisation; nine patients with moderate CAD (50\u201369% stenosis; 7%) and 389 with severe CAD (\u2265\u200970% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed\u2010days (43% reduction) and $7.3\u2009million in health care costs (36% reduction) would have been saved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Many rural and remote Western Australians transferred for ICA in Perth have non\u2010obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost\u2010effective strategy for risk stratification of people with suspected CAD.<\/jats:p><\/jats:sec>","DOI":"10.5694\/mja2.52018","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T06:43:35Z","timestamp":1688539415000},"page":"155-161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost\u2010effective alternative care model: a retrospective cross\u2010sectional study"],"prefix":"10.5694","volume":"219","author":[{"given":"Mikhail","family":"Alexander","sequence":"first","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"},{"name":"Royal Perth Hospital  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7222-7314","authenticated-orcid":false,"given":"Nick S R","family":"Lan","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"},{"name":"The University of Western Australia  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Dallo","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom G","family":"Briffa","sequence":"additional","affiliation":[{"name":"The University of Western Australia  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-0787","authenticated-orcid":false,"given":"Frank M","family":"Sanfilippo","sequence":"additional","affiliation":[{"name":"The University of Western Australia  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hooper","sequence":"additional","affiliation":[{"name":"Medical Royal Flying Doctor Service Western Australia  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6128-1606","authenticated-orcid":false,"given":"Helen","family":"Bartholomew","sequence":"additional","affiliation":[{"name":"Medical Royal Flying Doctor Service Western Australia  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loletta","family":"Hii","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham S","family":"Hillis","sequence":"additional","affiliation":[{"name":"Royal Perth Hospital  Perth WA"},{"name":"The University of Western Australia  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan M","family":"McQuillan","sequence":"additional","affiliation":[{"name":"The University of Western Australia  Perth WA"},{"name":"Sir Charles Gairdner Hospital  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Dwivedi","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"},{"name":"Harry Perkins Institute of Medical Research  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Rankin","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Rahman","family":"Ihdayhid","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital  Perth WA"},{"name":"Harry Perkins Institute of Medical Research  Perth WA"},{"name":"Curtin Medical School, Curtin University  Perth WA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,4]]},"reference":[{"key":"e_1_2_8_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2016.06.1213"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-14-58"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.101181"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907272"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2022.12.003"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.066"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2020.12.014"},{"key":"e_1_2_8_9_1","unstructured":"Australian Department of Health and Aged Care.Modified Monash Model. 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