The Centre of Research Excellence (CRE) to Reduce Inequality in Heart Disease focuses on improving the heart health and outcomes of groups and communities i.e. Regional Australians, Indigenous Australians and International Health

Healthy Hearts Beyond City Limits

Research Stream: Regional Australians

 

HealthyHeartsstudyim1.jpg - largeCardiovascular disease is consistently found to be more prevalent in regional and remote Australia compared to metropolitan areas. The aim of the Healthy Hearts Beyond City Limits program was to further explore these potential differentials to not only determine age and sex specific risk factor levels but the potential value of dedicated clinics to protect the heart health of regional communities.

  

Full Study Title

Healthy Hearts Beyond City Limits

 

Funding Sources

Rotary Club of Melbourne, participating Rotary Clubs in Colac, Shepparton and Bairnsdale and internal funding from Baker IDI Heart and Diabetes Institute.

 

Rationale for the Study

Any focus on reducing cardiovascular risk levels has to consider higher risk populations. People living in regional, rural or remote locations consistently fare worse than their metropolitan counterparts [1-3], with mortality rates rising in accord with remoteness [1]. Unfortunately, reliable (measured) population data, especially for biomedical health risk factors, are over 10 years old and limited in respect to regional data. This extends to the AusDiab Study and local Crossroads Undiagnosed Disease Study. Moreover, most cardiac services are concentrated in metropolitan areas.[4]

 

Study Aims

The overall aim of the Healthy Hearts Beyond City Limits program was two-fold; firstly to confirm elevated levels of cardiovascular risk in key regional Victorian communities according to age and sex, secondly to simultaneously determine the scope to engage such communities and individuals to reduce elevated levels of risk (if confirmed) through regional risk management clinics.

 

Study Design

Healthy Hearts Beyond City Limits was a regional observational research study. In order to distribute limited resources to areas that required it most, we used Geographical Information System profiling to identify regional cities with >20,000 total population in Victoria and which had an increased prevalence of chronic heart failure, Aboriginal and Torres Strait Islanders, obese children aged 7-18 years and adults over 65 years of age. Of 10 high risk communities identified, four relatively geographically dispersed were purposefully selected to visit. These included Colac (adult population of 7,172 and 152 km South-West of Melbourne), East Gippsland (11,251 and 294 km North-East of Melbourne), Geelong (3,664 and 75 km South-West of Melbourne) and Shepparton (20,410 and 190 km North of Melbourne).

 

Study Outcome

A total of 2,125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women) in the four target communities. Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p<0.001), pre-existing CVD (20 vs. 15%, p<0.01) and a major ECG abnormaility requiring follow up (OR 2.35, 95% CI 1.75 to 3.16). A higher proportion of women were obese (adjusted OR 1.39, 95% CI 1.16 to 1.65), physically inactive (adjusted OR 1.47, 95% CI 1.25 to 1.80) and reported depressive symptoms compared to men (28 vs 22%, p <0.01).

 

Ongoing Research/Translational Potential

The results of this study directly led to our undertaking the Protecting Health Hearts Study in addition to the proposed MODERN Trial focusing on the potential benefits of a regional risk clinic intervention for people living with metabolic disease/risk factors in regional Australia (details of the study will be posted prior to study commencement).

 

This study has also contributed greatly to the Victorian Government’s WorkHealth initiative, as well as our ongoing efforts in respect to national risk factor surveillance studies ; the Cholesterol Complacency Report, the Pressure Points in Primary Care Report and the recently completed VIPER-BP Study.

 

 

Key Collaborators

 

Key References

  1. Australian Institute of Health and Welfare. Prevention of cardiovascular disease, diabetes and chronic kidney disease: Targeting risk factors. Canberra, ACT, Australia; 2009.
  2. Department of Health. Victorian population health survey report 2008. Melbourne, Victoria: Department of Health; 2008.
  3. Carrington MJ, Jennings GL, Stewart S. Pattern of blood pressure in Australian adults: results from a national blood pressure screening day of 13,825 adults. Int J Cardiol 2010; 145(3):461-467.
  4. Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event: The Cardiac Accessibility and Remoteness Index for Australia (ARIA) Project. Circulation. 2012;125(16):2006-2014.

Study Publications

  1. Carrington MJ, Jennings GL, Clark RA, Stewart S. Assessing cardiovascular risk in regional areas: the healthy hearts -- beyond city limits program. BMC Health Serv Res. 2012;12(1):296.
  2. Carrington MJ, Retegan C, Johnston CI, Jennings GL, Stewart S. Cholesterol complacency in Australia: time to revisit the basics of cardiovascular disease prevention. J Clin Nurs. 2009;18(5):678-86.
  3. Carrington MJ, Jennings GL, Stewart S. Pressure points in primary care: blood pressure and management of hypertension in 532 050 patients from 2005 to 2010. J Hypertens. 2013;31(6):1265-71.
  4. Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event: The Cardiac Accessibility and Remoteness Index for Australia (ARIA) Project. Circulation. 2012;125(16):2006-2014.