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Abstract

This narrative review explores relevant literature that is related to the challenges inimplementing evidence-based management for clinicians in rural and remote areas, while primarilyfocussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literaturesearch around rural/urban dierences in the management of ACS, cardiovascular disease, and cardiacrehabilitation identified multiple issues that are related to access, including the ability to pay, transportand geographic distances, delays in patients seeking care, access to diagnostic testing, and timelytreatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise,cultural dierences, and complexity that arises from comorbidities and from geographical isolationamplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must actquickly to achieve optimal patient outcomes. New technologies and quality improvement approachesenable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake ofcardiac rehabilitation in rural and remote settings poses challenges that may reduce with the useof alternative models to centre-based rehabilitation and use of modern technologies. Expeditingimprovement in cardiovascular outcomes and reducing rural disparities requires system changesand that clinicians embrace attention to prevention, emergency management, and follow up care inrural contexts.

Item Type:	Article
Authors/Creators:	Thompson, SC and Nedkoff, L and Katzenellenbogen, J and Hussain, MA and Sanfilippo, F
Keywords:	rural, remote, acute coronary syndrome, revascularization, cardiac rehabilitation, cardiovascular, prevention, workforce, primary care, access, outcomes, review
Journal or Publication Title:	International Journal of Environmental Research and Public Health
Publisher:	M D P I AG
ISSN:	1661-7827
DOI / ID Number:	https://doi.org/10.3390/ijerph16245126
Copyright Information:	Copyright 2019 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/
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