title: Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study.
abstract: OBJECTIVE
  To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia.
  
  
  METHODS
  A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study.
  
  
  METHODS
  Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998.
  
  
  METHODS
  CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study.
  
  
  RESULTS
  There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of beta-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended "evidence-based practice" diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%).
  
  
  CONCLUSIONS
  This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.
authors.affiliation: Faculty of Health Sciences, University of South Australia, Adelaide, SA, Australia.
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
authors.forename: Kerena A
authors.initials: KA
authors.lastname: Eckert
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: Susan M
authors.initials: SM
authors.lastname: Phillips
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Yallop
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D004452:Echocardiography / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014505:Urban Population
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors