Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

Iyngkaran, Pupalan; Kangaharan, N.; Zimmet, Hendrik; Arstall, Margaret; Minson, Rob; Thomas, Merlin C.; Bergin, Peter; Atherton, J.; MacDonald, Peter B.; Hare, David; Horowitz, John D.; Ilton, Marcus

doi:10.2174/1573403x12666160606115034

Cited by 7 publications

(10 citation statements)

References 122 publications

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“…There is no published evidence of a comprehensive prospective CHF audit. Discussions on Indigenous Australians are presented elsewhere [ 87 ]. There are however national and selective state based data to suggest that many aspects of comprehensive CHF care are comparable or better than internationally published standards particularly in mortality and utilization of best practice.…”

Section: What Is the Evidence For Phase 4 Studies In Heart Failure?mentioning

confidence: 99%

Phase 4 Studies in Heart Failure - What is Done and What is Needed?

Iyngkaran

Liew²,

McDonald³

et al. 2016

CCR

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Congestive heart failure (CHF) therapeutics is generated through a well-described evidence generating process. Phases 1 – 3 of this process are required prior to approval and widespread clinical use. Phase 3 in almost all cases is a methodologically sound randomized controlled trial (RCT). After this phase it is generally accepted that the treatment has a significant, independent and prognostically beneficial effect on the pathophysiological process. A major criticism of RCTs is the population to whom the result is applicable. When this population is significantly different from the trial cohort the external validity comes into question. Should the continuation of the evidence generating process continue these problems might be identified. Post marketing surveillance through phase 4 and comparative effectiveness studies through phase 5 trials are often underperformed in comparison to the RCT. These processes can help identify remote adverse events and define new hypotheses for community level benefits. This review is aimed at exploring the post-marketing scene for CHF therapeutics from an Australian health system perspective. We explore the phases of clinical trials, the level of evidence currently available and options for ensuring greater accountability for community level CHF clinical outcomes.

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Section: What Is the Evidence For Phase 4 Studies In Heart Failure?mentioning

confidence: 99%

Phase 4 Studies in Heart Failure - What is Done and What is Needed?

Iyngkaran

Liew²,

McDonald³

et al. 2016

CCR

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“…Acquired risk factors including cigarette smoking, excess alcohol consumptions and certain recreational drugs are more prevalent. Aspects of CHF in the Aboriginal community have been explored in another publication within this theme [ 15 , 72 ]. Aboriginal focused cardiovascular genetics research has been lacking.…”

Section: Genetics In Indigenous Australiansmentioning

confidence: 99%

Contextualizing Genetics for Regional Heart Failure Care

Iyngkaran

Thomas²,

Johnson³

et al. 2016

CCR

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Congestive heart failure (CHF) is a chronic and often devastating cardiovascular disorder with no cure. There has been much advancement in the last two decades that has seen improvements in morbidity and mortality. Clinicians have also noted variations in the responses to therapies. More detailed observations also point to clusters of diseases, phenotypic groupings, unusual severity and the rates at which CHF occurs. Medical genetics is playing an increasingly important role in answering some of these observations. This developing field in many respects provides more information than is currently clinically applicable. This includes making sense of the established single gene mutations or uncommon private mutations. In this thematic series which discusses the many factors that could be relevant for CHF care, once established treatments are available in the communities; this section addresses a contextual role for medical genetics.

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“…2,3 These patient populations exhibit higher rates of HF risk factors, including ischaemic heart disease, hypertension and rheumatic heart disease (RHD) and associated comorbidities such as diabetes and severe chronic kidney disease (CKD), [4][5][6] whereas lower rates of both prescription and adherence to guideline-directed HF therapy have been well documented. [7][8][9] Previous studies exploring echocardiographic data specific to Indigenous Australians with HF have demonstrated incomplete data capture or included small patient numbers. 3,10 Worse cardiovascular outcomes seen in Indigenous Australians are multifactorial and stem not only from geographic and socioeconomic barriers to accessing health care but also a Conflict of interest: None.…”

Section: Introductionmentioning

confidence: 99%

“…Estimates of HF prevalence within Australia range from 2% to 5%; however, these numbers may be increased twofold to threefold in Indigenous Australian and nonurban communities 2,3 . These patient populations exhibit higher rates of HF risk factors, including ischaemic heart disease, hypertension and rheumatic heart disease (RHD) and associated comorbidities such as diabetes and severe chronic kidney disease (CKD), 4–6 whereas lower rates of both prescription and adherence to guideline‐directed HF therapy have been well documented 7–9 . Previous studies exploring echocardiographic data specific to Indigenous Australians with HF have demonstrated incomplete data capture or included small patient numbers 3,10 .…”

Section: Introductionmentioning

confidence: 99%

Heart failure among Indigenous and non‐Indigenous Australians in remote Central Australia

Rajamohan,

Jayhoon,

Gomez

et al. 2023

Internal Medicine Journal

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BackgroundThere is a paucity of data on the burden of heart failure (HF) in Central Australia, the most populous Indigenous region in the country.AimsTo characterize Indigenous and non‐Indigenous Australians with HF in Central Australia.MethodsConsecutive patients with HF and reduced ejection fraction <50% were included for the period 2019 to 2021. Clinical, echocardiographic and major adverse cardiovascular events (MACE) data were collected.ResultsFour hundred twenty‐four patients with HF were included (70% Indigenous, 59% male; follow‐up 2.2 ± 0.5 years). Indigenous Australians were younger (53 ± 15 vs 68 ± 13 years, P < 0.001) with higher rates of rheumatic heart disease (18% vs 1%, P < 0.001), diabetes (63% vs 33%, P < 0.001) and severe chronic kidney disease (CKD; 32% vs 7%, P < 0.001). HF was more prevalent among Indigenous (138 [95% confidence interval (CI), 123–155] per 10 000) compared with non‐Indigenous Australians (53 [95% CI, 44–63] per 10 000), particularly among younger individuals and females. There were similar HF aetiologies between groups. Guideline‐directed medical therapy (GDMT) was suboptimal and similar between the groups: angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker (64% vs 67%, P = 0.47) and β‐blockers (68% vs 71%, P = 0.47). Indigenous Australians had a significantly higher rate of MACE (54% vs 28%, P < 0.001) and death from any cause (24% vs 13%, P = 0.013).ConclusionsHF is more than two times as prevalent among Indigenous Central Australians, particularly among younger individuals and females. Despite similar HF aetiologies and GDMT, MACE and mortality outcomes are higher in Indigenous individuals with HF. These data have implications for efforts to close the Indigenous gap in morbidity and mortality.

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Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

Cited by 7 publications

References 122 publications

Phase 4 Studies in Heart Failure - What is Done and What is Needed?

Phase 4 Studies in Heart Failure - What is Done and What is Needed?

Contextualizing Genetics for Regional Heart Failure Care

Heart failure among Indigenous and non‐Indigenous Australians in remote Central Australia

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