title: Northern Territory perspectives on heart failure with comorbidities – understanding trial validity and exploring collaborative opportunities to broaden the evidence base.
abstract: Congestive Heart Failure (CHF) is an ambulatory care sensitive condition, associated with significant morbidity and mortality, rarely with cure. Outpatient based pharmacological management represents the main and most important aspect of care, and is usually lifelong. This narrative styled opinion review looks at the pharmacological agents recommended in the guidelines in context of the Northern Territory (NT) of Australia. We explore the concept of validity, a term used to describe the basis of standardising a particular trial or study and the population to which it is applicable. We aim to highlight the problems of the current guidelines based approach. We also present alternatives that could utilise the core principles from major trials, while incorporating regional considerations, which could benefit clients living in the NT and remote Australia.
authors: Royal Darwin Hospital, Flinders University, Darwin Private Hospital, Tiwi, NT 0811. Electronic address: balaniyngkaran@hotmail.com.
authors: P
authors: P
authors: Iyngkaran
authors: Royal Darwin Hospital, Department of Nephrology Division of Medicine. Electronic address: william.majoni@nt.gov.au.
authors: W
authors: W
authors: Majoni
authors: Menzies School of Health Research, Casuarina NT 0811. Electronic address: alan.cass@menzies.edu.au.
authors: A
authors: A
authors: Cass
authors: Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: prash.sanders@adelaide.edu.au.
authors: Prashanthan
authors: P
authors: Sanders
authors: Department of Nephrology Dialysis & Transplantation, International Renal Research Institute (IRRIV) San Bortolo Hospital, Vicenza, Italy. Electronic address: cronco@goldnet.it.
authors: C
authors: C
authors: Ronco
authors: Alice Springs Hospital, Alice Springs NT 0871. Electronic address: stephen.brady@nt.gov.au.
authors: S
authors: S
authors: Brady
authors: Division of Medicine, Royal Darwin Hospital, Royal Darwin Hospital, Tiwi, NT 0810. Electronic address: kanganada@gmail.co.
authors: N
authors: N
authors: Kangaharan
authors: Royal Darwin Hospital, Royal Darwin Hospital, Tiwi, NT 0810. Electronic address: marcus.ilton@gmail.com.
authors: M
authors: M
authors: Ilton
authors: Coordinator, Cardiovascular Research, University of Melbourne; Director of Heart Failure Services, Austin Health, Vic 3084. Electronic address: davidlh@unimelb.edu.au.
authors: D L
authors: DL
authors: Hare
authors: Baker IDI Heart and Diabetes Institute, Central Melbourne Victoria 3004, Australia. Electronic address: merlin.thomas@bakeridi.edu.au.
authors: M C
authors: MC
authors: Thomas
mesh_terms: D001315:Australia; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D015876:Northern Territory; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results
chemical_list: D002317:Cardiovascular Agents
keywords: Guidelines; Heart Failure; Indigenous Australians; Remote; Rural; Therapeutics