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The Challenge

According to the Australian Bureau of Statistics, the rate of heart disease in rural and remote local government areas is higher than in major cities.  

For example, data shows that the rate of heart disease per 100 ASR in Walgett Shire in 2021 was 4.1, 5.3 in Brewarrina and 4.9 in Bourke compared to a rate of 3.8 per 100 ASR in NSW.

Certain types of arrhythmia (abnormal heart beats) only happen under certain conditions, such as stress or activity. Arrhythmias of this type are hard to record on an Electrocardiogram (ECG) done in a hospital or primary health clinic. 

A Holter monitor is a portable electrocardiogram (ECG) machine that a patient wears over an extended period.  The monitor records data about the patient's heart during the day and night while it is worn which can then be examined by a GP or Nurse Practitioner to determine whether there is anything going wrong with the heart. 

Electrodes (small, plastic patches that stick to the skin) are placed at certain points on the chest and abdomen. The electrodes are connected to an ECG machine by wires. Then, the electrical activity of the heart can be measured, recorded, and printed. No electricity is sent into the body. The aim is just to get a better information about any abnormal heartbeats or rhythms that may be causing the problems. 

Poor access to cardiovascular care in rural, remote and Aboriginal communities contributes to substantially higher rates of avoidable hospital admissions and deaths from heart disease compared to larger cities.  For example, the rate of avoidable deaths from heart disease in Walgett was 61.4 per 100,000 ASR, 145 in Brewarrina and 115.2 in Bourke compared to a NSW Average of 19.6 per 100,000 ASR.

This may reflect the challenge of travelling to large regional cities or major cities to undertaken monitoring at times when issues may not be present, or patients avoiding proper monitoring due to the cost of travel.

Theory of Change

Increasing access to long-term monitoring of heart health will increase detection of potential heart problems and reduce avoidable hospitalisations and deaths in rural, remote and Aboriginal communities.

Anticipated Outcomes

Short-Intermediate Term

  1. Increase in the number of patients provided with a Holter Monitor.

  2. Increase in detection of arrhythmia.

  3. Increased patient satisfaction with the quality of heart care.

Long Term Outcomes

  1. Reduction in avoidable hospitalisations and deaths due to improved access to prevention and early intervention.



Number of patients provided with a Holter Monitor

Arrhythmia Detection

Increase in detection of arrhythmia in at-risk patients


Increase in patient self-assessed satisfaction with care

15 April 2024

NOTE: Funding for the Clinic was announced in January 2024 and services will commence in the middle of the year.

Social Impact


  1. Primary Health Information Development Unit, Torrens University (2021) Social Health Atlas - Data by Local Government Area at

  2. John Hopkins Medical Centre (2023) What is a Holter Monitor? at,used%20to%20evaluate%20the%20heart.


Use of remote monitoring using a Holter Monitor to reduce heart attack and stroke risk in rural and remote patients presenting with indicators of heart problems.

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