Management of heart conditions in older rural and urban Australian women

Background: Cardiovascular disease death rates are higher among Australians from regional and remote areas than those from major cities. Aims: To investigate the causes of excess mortality from heart disease in rural compared to urban Australian women aged over 75 years. Methods: In 2004, 944 older urban and rural participants in the Australian Longitudinal Study on Women's Health aged 77–83 years with self‐reported ischaemic heart disease (IHD), heart failure or atrial fibrillation took part in a nested cross‐sectional substudy. We used clinical guidelines to determine key management issues for these conditions. Using logistic regression we calculated odds ratios (OR) and 95% confidence intervals (CI) to assess the relationship between management and area of residence. Results: These older Australian women often did not receive recommended management for their heart conditions. Only 30% reported having had an echocardiogram. Reported use of statins and beta‐blockers was low among women with IHD (58% and 41% respectively) and only 32% of women reporting heart failure were taking angiotensin‐converting enzyme inhibitors. Women from regional/remote areas had greater odds of reporting never having seen a cardiologist (OR = 3.88, 95% CI 1.72–8.72) and never having had an echocardiogram than women from major cities (OR = 2.86, 95% CI 1.42–5.75). Medication use was similar for rural and urban women. Conclusions: Our results suggest that best‐practice treatments for heart conditions are suboptimally provided to older women. In addition, they suggest differential use of some health services, which might help explain higher cardiovascular mortality among rural compared with urban women.