title: Chronic heart failure beyond city limits.
abstract: BACKGROUND
  Chronic heart failure (CHF) develops in frail elderly individuals who have suffered an acute or sustained insult to the structural efficiency of the heart due to the presence of underlying heart disease and/or hypertension. It is also more common in individuals with disproportionately high levels of cardiac disease or its risk factors, for example lower socioeconomic status. As such, this epidemic is particularly significant for older people, males and Aboriginal people; groups who comprise a greater proportion of the population in rural and remote Australia. The aim of this study is to determine if the rates of CHF differ between urban and rural Australia.
  
  
  METHODS
  CHF prevalence rates derived from well validated international CHF prevalence data were applied to the Australian Bureau of Statistics Census data for 2001 and weighted to reflect the proportion of Aboriginal people in each geographical stratum.
  
  
  RESULTS
  Australia wide, the estimated prevalence of CHF was 17.87 per 1000, ranging from 13.98/1000 in the Australian Capital Territory to 29.50/1000 in rural Northern Territory. Overall, CHF was more prevalent in rural and remote regions (19.84/1000) and large urban centres (19.01/1000) than in capital cities (16.94/1000) (p<0.001). High prevalence rates were also noted in the idyllic rural locations favoured by retirees. In Victoria, Western Australia, South Australia and the Australian Capital Territory over 70% of the estimated individual cases were located in capital cities. In New South Wales, Queensland, Tasmania and the Northern Territory the highest proportion of cases occurred outside capital cities.
  
  
  CONCLUSIONS
  The main significance of these findings is that while a majority of heart failure may occur among people living in cities (because that is where most people live), a disproportionate number of cases occur among people living outside these cities (due to age and other socio-demographic risk factors) where services may be fewer and less accessible.
authors.affiliation: The University of South Australia, Adelaide, South Australia, Australia. robyn.clark@unisa.edu.au
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
authors.forename: Skye
authors.initials: S
authors.lastname: McLennan
authors.forename: Kerena
authors.initials: K
authors.lastname: Eckert
authors.forename: Anna
authors.initials: A
authors.lastname: Dawson
authors.forename: David
authors.initials: D
authors.lastname: Wilkinson
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010821:Physicians, Family / Q000600:supply & distribution*; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data*; D000078329:Workforce