{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:12:59Z","timestamp":1791400379663,"version":"4.3.3"},"reference-count":124,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2019,12,15]],"date-time":"2019-12-15T00:00:00Z","timestamp":1576368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1031057;"],"award-info":[{"award-number":["1031057;"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph16245126","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T05:19:38Z","timestamp":1576473578000},"page":"5126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0327-7155","authenticated-orcid":false,"given":"Sandra C.","family":"Thompson","sequence":"first","affiliation":[{"name":"Western Australian Centre for Rural Health, The University of Western Australia, P.O. Box 109, Geraldton 6531, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Nedkoff","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Katzenellenbogen","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6012-3702","authenticated-orcid":false,"given":"Mohammad Akhtar","family":"Hussain","sequence":"additional","affiliation":[{"name":"Western Australian Centre for Rural Health, The University of Western Australia, P.O. Box 109, Geraldton 6531, Australia"},{"name":"Menzies Institute for Medical Research, University of Tasmania, 15-17 Liverpool Street, Hobart, Tasmania 7000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-0787","authenticated-orcid":false,"given":"Frank","family":"Sanfilippo","sequence":"additional","affiliation":[{"name":"School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1001\/jama.2016.4226","article-title":"The association between income and life expectancy in the united states, 2001\u20132014","volume":"315","author":"Chetty","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1016\/j.jacc.2008.08.049","article-title":"Global inequalities in access to cardiovascular health care: Our greatest challenge","volume":"52","author":"Joshi","year":"2008","journal-title":"J. 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