Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

• Published in: International journal of environmental research and public health 2019-12, Vol.16 (24), p.5126
• Main Authors: Thompson, Sandra C, Nedkoff, Lee, Katzenellenbogen, Judith, Hussain, Mohammad Akhtar, Sanfilippo, Frank
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Acute Disease; Aftercare; Arrhythmia; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - therapy; Coronary artery; Disease control; Disease management; Disease prevention; Fibrillation; Health care access; Health risk assessment; Heart attacks; High income; Hospitals, Rural - organization & administration; Humans; Hypertension; Implants; Literature reviews; Metropolitan areas; Mortality; Native peoples; Nutrition; Prevention; Public health; Quality of Health Care; Rehabilitation; Review; Rural areas; Rural Health Services - organization & administration; Rural Population; Smoking; Statins; Ventricle; Ventricular fibrillation; Warfarin
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph16245126

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.