Mending Hearts in Northland: It's Not Rocket Science

Abstract

Applying heart failure (HF) guidelines in a rural hospital clinic setting can result in significant improvements in patient outcomes. We describe the early days of a rural HF service. Northland has one of the highest cardiovascular disease and death rates in the country; in addition, access to primary care is suboptimal for a variety of reasons. In late 2019, a cardiologist with an HF interest took over the responsibility of cardiology clinics in the mid and far North. The data below relate to 86 consecutive cardiology clinic patients with a diagnosis of HF reduced ejection fraction (rEF), attending either Kaitaia or Bay Of Islands hospitals between October 2019 and March 2020. Of the patients, 85% were male and 71% Māori. The average age was 62.2 years, ranging 25–84 years with a median of 63 years. In addition, 38% were diabetic, almost all type 2. Causative and contributing factors for HF included ischaemic heart disease in 24% and alcohol in 41%. Methamphetamine and familial/genetic causes were involved in 7% each. Usual guideline recommended HF therapy was utilised and patients followed up with ejection fraction (EF) results are shown below.Tabled 1Year20182019202020212022Average EF%29.729.930.435.338.8 Open table in a new tab Four of 86 patients died, five relocated, and there were issues with adherence that likely contributed to delayed and/or poorer outcomes in 15%. Contributors to EF improvement will be described elsewhere. This real-life data highlight the complex burden of HF in rural Northland, but how relatively successful a guideline-focused management strategy can be.