Heart Failure Treatment in Northern Australia: Can We Do Better?

Abstract

Background: Heart failure (HF) is a significant cause of disease burden for Indigenous Australians. Understanding the prevalence, aetiology and treatment in Indigenous populations is vital to improving health outcomes. Aim: To compare the management of systolic HF between Indigenous and non-indigenous populations in the Northern Territory. Methods: A retrospective study of systolic heart failure admissions between July 2016 and July 2017 was performed. Data collected included patient demographics, co-morbidities, echocardiographic findings, medical therapy and 12-month outcomes. Results: There were 102 patients; 51 Indigenous and 52 non-indigenous (prevalence 77/100,000 vs 29/100,000). Indigenous patients were younger (52 years vs 72 years, p-value <0.01) and more likely female (45% vs 27%, p-value <0.01) with higher rates of rheumatic heart disease (15.6% vs 0% p-value <0.01) and chronic kidney disease (74.5% vs 50% p-value <0.01). Ischaemic cardiomyopathy was the most common aetiology in both groups (41.2%, 44%). Beta-blockers were the most prescribed treatment in both groups (86.2%, 75%) with lower rates of ACE-inhibitor (68.6%, 63.4%) and aldosterone antagonist (66.6%, 54%). At 12 months, treatment prescription had not reduced significantly for Indigenous patients. Readmission rates for heart failure were high (74.5% vs 61.5%) with 6 deaths in each group. Conclusion: Indigenous patients are younger, more likely to be female and have a markedly higher prevalence of systolic heart failure than their non-indigenous counterparts. Their burden of chronic disease is significant and rehospitalisation rates are high. Addressing the underlying causes of heart failure and barriers to treatment adherence are necessary to reduce the disease burden.