Heart failure

Heart failure treatment in the regions on par with metropolitan areas

Heart failure patients in regional Australia are receiving guideline directed medical therapy and achieving good outcomes, according to a study from the North Queensland city of Mackay.

The retrospective study of 115 new and pre-existing HF patients seen in the nurse-led heart failure titration clinic between March 2019 and March 2020 found more than 90% of patients were on maximal doses of RAAS inhibitors and beta blockers.

Angiotensin receptor-neprilysin inhibitors (ARNi) were used by 62% of patients, ACE inhibitors by 23% and angiotensin receptor blockers by 9%. Bisoprolol was the most commonly used beta blocker (80%).

The study, published in Heart, Lung & Circulation, found the majority of patients (97%) had HFrEF with a mean LVEF of 31 at diagnosis.

The most common aetiology for heart failure was ischaemia (54%), idiopathic cardiomyopathy (32%), drugs including amphetamines, alcohol and chemotherapy (11%), valvular heart disease (2%) and Takotsubo cardiomyopathy (1%).

Risk factors and comorbidities associated with heart failure in the cohort included smoking (59%), hypertension (57%), AF (44%), (43%), obesity (43%) and alcohol abuse (43%).

While male patients were diagnosed with heart failure younger than female patients, the risk factor profiles were found to be similar.

“This study has provided much needed information into the root causes of heart failure in Mackay region which will enable our health service to prioritise the health resources accordingly,” the study said.

For example: “We have demonstrated that ischaemic heart disease continues to be the leading cause of heart failure in our cohort which justifies the availability of round-the-clock percutaneous coronary intervention service in this region.”

Lead author Dr Pyi Naing, a general physician and cardiology advanced trainee now on rotation at Prince Charles Hospital in Brisbane, told the limbic it was reassuring to see patients in a regional area receiving the same quality care as patients in metropolitan hospitals.

In particular, he said the education, support and follow-up patients received via the nurse-led HF titration clinic was important.

“What I’ve seen in other places where I used to work is that patients six months down track from their initial diagnosis were still not being treated properly. They were remaining on very low doses of medications prescribed on discharge from the hospital.”

He said that given most of the study’s patients had severe heart failure, the mortality rate of three deaths during a follow-up period of 403 days was low compared to other evidence.

The study said further follow-up to ensure patient adherence to and further optimisation of guideline-based therapy was required to maintain this trend.

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