Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study

Robyn A Clark, Kerena A Eckert, Simon Stewart, Susan M Phillips, Julie Jane Yallop, Andrew Maxwell Tonkin, Henry Krum

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OBJECTIVE: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. DESIGN: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. SETTING: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. MAIN OUTCOME MEASURES: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. RESULTS: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1 ) compared with capital city and metropolitan areas (12.4 ) (P <0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0 v 67.3 , P <0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1 v 69.6 , P <0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4 v 60.1 , P <0.001). There was no geographical variation in prescribing rates of beta-blockers (12.6 [rural] v 11.8 [metropolitan], P = 0.32). Overall, few survey participants received recommended evidence-based practice diagnosis and management for CHF (metropolitan, 4.6 ; rural, 3.9 ; and remote areas, 3.7 ). CONCLUSIONS: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.
Original languageEnglish
Pages (from-to)441 - 445
Number of pages5
JournalThe Medical Journal of Australia
Issue number9
Publication statusPublished - 2007

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