# Prevention and Management of Heart Failure Associated with Type 2 Diabetics in Rural Australia

## TL;DR

This paper discusses the higher rates of heart failure and diabetes hospitalizations in rural Australia and suggests solutions like better healthcare access and workforce support.

## Contribution

The paper highlights the disparity in heart failure and diabetes outcomes in rural Australia and proposes targeted interventions to address these issues.

## Key findings

- Heart failure hospitalization rates in remote areas are 1.8 times higher than in major cities.
- Diabetes hospitalizations in remote areas are 2.5 times higher than in major cities.
- SGLT2 inhibitors have been shown to reduce HF hospitalizations in HFpEF patients.

## Abstract

Background: Heart failure (HF) patients with a ‘reduced’ ejection fraction (HFrEF) have several proven treatment options, but for those with a ‘preserved’ ejection fraction (HFpEF) there are very few. However, recent trials such as the EMPEROR-Preserved and DELIVER have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce HF hospitalization in HFpEF patients, and these are now supported by both Australian and international guidelines. Methods: We undertook a narrative review using a structured multi-database search (MEDLINE, Embase, CINAHL, Scopus) and key Australian sources (AIHW, ABS, Department of Health and Aged Care) without geographic or publication-year restrictions. Results: In Australia there were approximately 179,000 hospitalizations in 2020–2021 due to HF equating to a rate of 697 per 100,000 population. The age-standardized hospitalization rate for HF in remote and very remote areas was 1.8 times higher than in major cities. Likewise, since 2000 the prevalence of diabetes has nearly tripled, from 460,000 to 1.3 million. In remote areas, there were 47,600 diabetes hospitalizations in 2021–2022, with residents being 2.5 times more likely to be hospitalized for diabetes compared to those in major cities. Conclusions: In rural Australia, reducing preventable hospitalizations and premature mortality from heart failure and type 2 diabetes requires a stronger rural generalist and general practitioner workforce, improved access to essential medicines and telehealth, and equity-focused evaluation.