Adherence to Treatment Guidelines in Heart Failure Patients in the Top End Region of Northern Territory

Monica Mu, Sandawana William Majoni, Pupalan Iyngkaran, Mark Haste, Nadarajah Kangaharan

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Heart failure (HF) is associated with significant morbidity and mortality and recurrent hospitalisations, particularly in the Indigenous Australians of the Northern Territory. In remote Northern Australia, the epidemiology is less clear but anecdotal evidence suggests it may be worse. In addition, some anecdotal evidence suggests that prognostic pharmacological therapy could also be underutilised. Minimal HF data exists in the remote and Indigenous settings, making this study unique. 

    Methods: A retrospective cohort review of pharmacological management of 99 patients from 1 January 2014 to 31 December 2014 was performed. 

    Results: Ninety-nine patients were identified. 59.6% were non-Indigenous vs 40.4% Indigenous. The majority was male (69.7%). Indigenous patients were younger; median age was 51.4 (43.4–60.6) vs 70.5 (62.2–77.0), p < 0.001. Major causes of HF were coronary artery disease (61%) and dilated cardiomyopathy (27%). Associated comorbidities included hypertension (52%), dyslipidaemia (38%), diabetes mellitus (40%) and atrial fibrillation (25%). The use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and β-blocker was 68% and 87%, respectively. Forty-one patients not on an ACEI/ARB and/or β-blocker were identified. Seventeen of those patients (42%) did not receive an ACEI/ARB because of renal failure. Four patients (10%) did not take a β-blocker due to hypotension. Fourteen patients (34%) were not prescribed an ACEI/ARB and/or β-blocker had no identifiable contraindications. 

    Conclusions: Indigenous patients are over-represented at a younger age demonstrating the alarming rate of disease burden in NT's young Indigenous population. Generally, ACEI/ARBs were underutilised compared to β-blockers with renal impairment being the primary contraindication. There is a need to develop processes to further improve the use of heart failure medications and setting up a HF database could be the first step in progress.

    Original languageEnglish
    Pages (from-to)1042-1049
    Number of pages8
    JournalHeart Lung and Circulation
    Volume28
    Issue number7
    Early online date19 Jun 2018
    DOIs
    Publication statusPublished - Jul 2019

    Fingerprint

    Northern Territory
    Heart Failure
    Guidelines
    Angiotensin Receptor Antagonists
    Angiotensin-Converting Enzyme Inhibitors
    Therapeutics
    Pharmacology
    Dilated Cardiomyopathy
    Dyslipidemias
    Population Groups
    Hypotension
    Atrial Fibrillation
    Renal Insufficiency
    Comorbidity
    Coronary Artery Disease
    Diabetes Mellitus
    Epidemiology
    Hospitalization
    Databases
    Hypertension

    Cite this

    Mu, Monica ; Majoni, Sandawana William ; Iyngkaran, Pupalan ; Haste, Mark ; Kangaharan, Nadarajah. / Adherence to Treatment Guidelines in Heart Failure Patients in the Top End Region of Northern Territory. In: Heart Lung and Circulation. 2019 ; Vol. 28, No. 7. pp. 1042-1049.
    @article{219d93f0a6bc497bab0243679b8c5d2c,
    title = "Adherence to Treatment Guidelines in Heart Failure Patients in the Top End Region of Northern Territory",
    abstract = "Background: Heart failure (HF) is associated with significant morbidity and mortality and recurrent hospitalisations, particularly in the Indigenous Australians of the Northern Territory. In remote Northern Australia, the epidemiology is less clear but anecdotal evidence suggests it may be worse. In addition, some anecdotal evidence suggests that prognostic pharmacological therapy could also be underutilised. Minimal HF data exists in the remote and Indigenous settings, making this study unique. Methods: A retrospective cohort review of pharmacological management of 99 patients from 1 January 2014 to 31 December 2014 was performed. Results: Ninety-nine patients were identified. 59.6{\%} were non-Indigenous vs 40.4{\%} Indigenous. The majority was male (69.7{\%}). Indigenous patients were younger; median age was 51.4 (43.4–60.6) vs 70.5 (62.2–77.0), p < 0.001. Major causes of HF were coronary artery disease (61{\%}) and dilated cardiomyopathy (27{\%}). Associated comorbidities included hypertension (52{\%}), dyslipidaemia (38{\%}), diabetes mellitus (40{\%}) and atrial fibrillation (25{\%}). The use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and β-blocker was 68{\%} and 87{\%}, respectively. Forty-one patients not on an ACEI/ARB and/or β-blocker were identified. Seventeen of those patients (42{\%}) did not receive an ACEI/ARB because of renal failure. Four patients (10{\%}) did not take a β-blocker due to hypotension. Fourteen patients (34{\%}) were not prescribed an ACEI/ARB and/or β-blocker had no identifiable contraindications. Conclusions: Indigenous patients are over-represented at a younger age demonstrating the alarming rate of disease burden in NT's young Indigenous population. Generally, ACEI/ARBs were underutilised compared to β-blockers with renal impairment being the primary contraindication. There is a need to develop processes to further improve the use of heart failure medications and setting up a HF database could be the first step in progress.",
    keywords = "Australia, Heart failure, Indigenous population, Treatment guidelines",
    author = "Monica Mu and Majoni, {Sandawana William} and Pupalan Iyngkaran and Mark Haste and Nadarajah Kangaharan",
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    Adherence to Treatment Guidelines in Heart Failure Patients in the Top End Region of Northern Territory. / Mu, Monica; Majoni, Sandawana William; Iyngkaran, Pupalan; Haste, Mark; Kangaharan, Nadarajah.

    In: Heart Lung and Circulation, Vol. 28, No. 7, 07.2019, p. 1042-1049.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Adherence to Treatment Guidelines in Heart Failure Patients in the Top End Region of Northern Territory

    AU - Mu, Monica

    AU - Majoni, Sandawana William

    AU - Iyngkaran, Pupalan

    AU - Haste, Mark

    AU - Kangaharan, Nadarajah

    PY - 2019/7

    Y1 - 2019/7

    N2 - Background: Heart failure (HF) is associated with significant morbidity and mortality and recurrent hospitalisations, particularly in the Indigenous Australians of the Northern Territory. In remote Northern Australia, the epidemiology is less clear but anecdotal evidence suggests it may be worse. In addition, some anecdotal evidence suggests that prognostic pharmacological therapy could also be underutilised. Minimal HF data exists in the remote and Indigenous settings, making this study unique. Methods: A retrospective cohort review of pharmacological management of 99 patients from 1 January 2014 to 31 December 2014 was performed. Results: Ninety-nine patients were identified. 59.6% were non-Indigenous vs 40.4% Indigenous. The majority was male (69.7%). Indigenous patients were younger; median age was 51.4 (43.4–60.6) vs 70.5 (62.2–77.0), p < 0.001. Major causes of HF were coronary artery disease (61%) and dilated cardiomyopathy (27%). Associated comorbidities included hypertension (52%), dyslipidaemia (38%), diabetes mellitus (40%) and atrial fibrillation (25%). The use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and β-blocker was 68% and 87%, respectively. Forty-one patients not on an ACEI/ARB and/or β-blocker were identified. Seventeen of those patients (42%) did not receive an ACEI/ARB because of renal failure. Four patients (10%) did not take a β-blocker due to hypotension. Fourteen patients (34%) were not prescribed an ACEI/ARB and/or β-blocker had no identifiable contraindications. Conclusions: Indigenous patients are over-represented at a younger age demonstrating the alarming rate of disease burden in NT's young Indigenous population. Generally, ACEI/ARBs were underutilised compared to β-blockers with renal impairment being the primary contraindication. There is a need to develop processes to further improve the use of heart failure medications and setting up a HF database could be the first step in progress.

    AB - Background: Heart failure (HF) is associated with significant morbidity and mortality and recurrent hospitalisations, particularly in the Indigenous Australians of the Northern Territory. In remote Northern Australia, the epidemiology is less clear but anecdotal evidence suggests it may be worse. In addition, some anecdotal evidence suggests that prognostic pharmacological therapy could also be underutilised. Minimal HF data exists in the remote and Indigenous settings, making this study unique. Methods: A retrospective cohort review of pharmacological management of 99 patients from 1 January 2014 to 31 December 2014 was performed. Results: Ninety-nine patients were identified. 59.6% were non-Indigenous vs 40.4% Indigenous. The majority was male (69.7%). Indigenous patients were younger; median age was 51.4 (43.4–60.6) vs 70.5 (62.2–77.0), p < 0.001. Major causes of HF were coronary artery disease (61%) and dilated cardiomyopathy (27%). Associated comorbidities included hypertension (52%), dyslipidaemia (38%), diabetes mellitus (40%) and atrial fibrillation (25%). The use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and β-blocker was 68% and 87%, respectively. Forty-one patients not on an ACEI/ARB and/or β-blocker were identified. Seventeen of those patients (42%) did not receive an ACEI/ARB because of renal failure. Four patients (10%) did not take a β-blocker due to hypotension. Fourteen patients (34%) were not prescribed an ACEI/ARB and/or β-blocker had no identifiable contraindications. Conclusions: Indigenous patients are over-represented at a younger age demonstrating the alarming rate of disease burden in NT's young Indigenous population. Generally, ACEI/ARBs were underutilised compared to β-blockers with renal impairment being the primary contraindication. There is a need to develop processes to further improve the use of heart failure medications and setting up a HF database could be the first step in progress.

    KW - Australia

    KW - Heart failure

    KW - Indigenous population

    KW - Treatment guidelines

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    U2 - 10.1016/j.hlc.2018.06.1038

    DO - 10.1016/j.hlc.2018.06.1038

    M3 - Article

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    SP - 1042

    EP - 1049

    JO - Heart Lung and Circulation

    JF - Heart Lung and Circulation

    SN - 1444-2892

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