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.
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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.",
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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.

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