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Prevention and Management of Heart Failure Associated with Type 2 Diabetics in Rural Australia
Allen G Ross1, Utpal K Mondal2, Shakeel Mahmood2
1College of Medicine, Ajman University, Ajman 346, United Arab Emirates.
Insights
Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce heart failure (HF) hospitalizations in HF with preserved ejection fraction (HFpEF) patients. Improving rural healthcare access and workforce is crucial for reducing preventable hospitalizations from HF and type 2 diabetes in Australia.
Area of Science:
- Cardiology
- Endocrinology
- Rural Health
Background:
- Heart failure with preserved ejection fraction (HFpEF) has limited treatment options.
- Recent trials show sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce HF hospitalizations in HFpEF.
- SGLT2 inhibitors are now supported by Australian and international guidelines for HFpEF.
Purpose of the Study:
- To review the effectiveness of SGLT2 inhibitors for HFpEF.
- To examine heart failure (HF) and diabetes hospitalization rates in Australia, particularly in rural areas.
- To identify strategies for reducing preventable hospitalizations and mortality in rural Australia.
Main Methods:
- Narrative review utilizing a structured multi-database search (MEDLINE, Embase, CINAHL, Scopus).
- Inclusion of key Australian health data sources (AIHW, ABS, Department of Health and Aged Care).
- No restrictions on geographic location or publication year.
Main Results:
- Approximately 179,000 HF hospitalizations in Australia (2020-2021), with higher rates in remote areas.
- Diabetes prevalence has nearly tripled since 2000, with significantly higher hospitalization rates in remote areas.
- Rural residents are 2.5 times more likely to be hospitalized for diabetes compared to major city residents.
Conclusions:
- Reducing preventable hospitalizations and premature mortality from heart failure and type 2 diabetes in rural Australia requires a stronger rural healthcare workforce.
- Improved access to essential medicines and telehealth is vital.
- Equity-focused evaluation is necessary to address disparities in rural healthcare outcomes.
Abstract:
Background: Heart failure (HF) patients with a 'reduced' ejection fraction (HFrEF) have several proven treatment options, but for those with a 'preserved' ejection fraction (HFpEF) there are very few. However, recent trials such as the EMPEROR-Preserved and DELIVER have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce HF hospitalization in HFpEF patients, and these are now supported by both Australian and international guidelines. Methods: We undertook a narrative review using a structured multi-database search (MEDLINE, Embase, CINAHL, Scopus) and key Australian sources (AIHW, ABS, Department of Health and Aged Care) without geographic or publication-year restrictions. Results: In Australia there were approximately 179,000 hospitalizations in 2020-2021 due to HF equating to a rate of 697 per 100,000 population. The age-standardized hospitalization rate for HF in remote and very remote areas was 1.8 times higher than in major cities. Likewise, since 2000 the prevalence of diabetes has nearly tripled, from 460,000 to 1.3 million. In remote areas, there were 47,600 diabetes hospitalizations in 2021-2022, with residents being 2.5 times more likely to be hospitalized for diabetes compared to those in major cities. Conclusions: In rural Australia, reducing preventable hospitalizations and premature mortality from heart failure and type 2 diabetes requires a stronger rural generalist and general practitioner workforce, improved access to essential medicines and telehealth, and equity-focused evaluation.
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