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

Abstract

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. A retrospective cohort review of pharmacological management of 99 patients from 1 January 2014 to 31 December 2014 was performed. Ninety-nine (99) 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 (41) patients not on an ACEI/ARB and/or β-blocker were identified. Seventeen (17) of those patients (42%) did not receive an ACEI/ARB because of renal failure. Four (4) patients (10%) did not take a β-blocker due to hypotension. Fourteen (14) patients (34%) were not prescribed an ACEI/ARB and/or β-blocker had no identifiable contraindications. 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.