Abstract: Background: People living in rural and remote areas are faced with a multitude of health disadvantages. These disadvantages include limited access and decreased utilisation of medical services, increased rates of modifiable and non-modifiable risk factors, decreased socioeconomic status and an increased disease prevalence across a wide variety of conditions (1-3). This is reflected through higher mortality rates in remote and very remote areas of Australia compared to people living in major cities for all-cause mortality (1). Although a number of health policies and government assistances are attempting to improve access to health facilities, the health gap remains (4). In particular, the cardiac health of rural and remote Australians is disadvantaged with patients in rural and remote areas exposed to higher mortality rates of coronary artery disease (3). Similarly to other specialist services, cardiology services are infrequently provided in the areas that have an increased burden of disease with decreased access to cardiac specialists and diagnostic services in rural and remote areas compared to major cities (5). It is therefore imperative timely access to cardiac testing is available to detect cardiac issues before it is too late. Aims: The research aimed to define the current service provision of the non-invasive cardiac diagnostics of exercise stress testing (EST) and Holter monitoring within two rural and remote hospital and health service (HHS) areas in Queensland. The specific objectives were to define the reporting processes for each testing procedure, the time frames for testing, the number of non-invasive cardiac investigation services performed and the travel implications to the HHS and the patient. Methods: A multi-site retrospective chart review was conducted at two rural hospitals within Queensland. Patients were included in the study if they had completed an exercise stress test and/or Holter monitoring within the specified 12 month period. Data were extracted from medical data sources including physical paper patient charts. Analysed documentation included testing reports, progress notes, patient travel spreadsheets and electronic reporting systems. Variables that were recorded included demographic details, patient’s postcodes, date stamps for a variety of time points throughout the referral/ testing process and patient travel subsidy information. Results: Results revealed three times the number of patients were serviced at Rural Hospital A for both EST and Holter monitoring compared to Rural Hospital B. Approximately 48% of exercise stress tests and 9% of Holter monitoring appointments breached the allocated categorisation period at Rural Hospital A. Rural Hospital B did not employ a categorisation system. Patients at Rural Hospital A waited almost twice as long compared to patients at Rural Hospital B to complete an EST. Additionally, Rural Hospital A waited twice as long for reporting of the EST by a cardiology specialist compared to Rural Hospital B. The overall process from the physician requesting the EST to the time the referring physician received the signed report were therefore elongated at Rural Hospital A compared to Rural Hospital B (96 vs 49 days). Similarly, Holter patients on average at Rural Hospital A waited longer to have the Holter monitor fitted (14 vs. 7 days), for cardiology specialist reporting (21 vs. 3 days) and the entire round process from the physician requesting a Holter monitor to the time the referring physician received the signed report back (45 vs. 14 days). The mean distance travelled for patients that underwent Holter monitoring and were required to travel was 667 ± 383 kilometres at Rural Hospital A and 394 ± 284 kilometres at Rural Hospital B. The mean distance travelled for patients that underwent an EST and were required to travel was 479 ± 343km at Rural Hospital A and 411 ± 301km at Rural Hospital B. The maximum return distance travelled for individual patients was observed at Rural Hospital B with patients travelling 1464km for Holter monitoring and ESTs. The greatest average return distance was observed at Rural Hospital A. Patients performing Holter monitoring travelled an average return distance of ~668 kilometres. It was recognised that patients at both facilities underutilised the patient travel subsidy scheme. Conclusions The results from this study illustrated significant differences in service methods and the impact on time to testing, reporting and subsequent local follow up once reports were returned to the local service provider. The reporting strategies observed were particularly timely with both hospitals utilising ineffective methods. Patients additionally were travelling long distances to seek diagnostic testing. Strategies such as outreach clinics and Telehealth services may be advantageous in improving access to specialist care without the need for patients to travel hundreds of kilometres. Innovative approaches and collaborative thinking amongst urban and rural health providers is required to minimise the geographical health divide.