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Gaps in cardiovascular disease risk management in Australian general practice

Ruth J Webster, Emma L Heeley, David P Peiris, Clare Bayram, Alan Cass and Anushka A Patel
Med J Aust 2009; 191 (6): 324-329.

Summary

Objective: To evaluate the management of cardiovascular disease (CVD) risk in Australian general practice.

Design, setting and participants: National cross-sectional survey of 99 Australian general practitioners participating in the Bettering the Evaluation and Care of Health (BEACH) program. Data on 2618 consecutive adult patients presenting to the participating GPs over a 5-week period from September to October 2006 were analysed.

Main outcome measures: Proportions of patients screened, treated and reaching targets according to (1) current Australian CVD risk guidelines and (2) overall or absolute CVD risk.

Results: Blood pressure (BP) had not been recorded for 13% of the sample. Of 1400 patients not prescribed antihypertensive medication, treatment was indicated for 8%. Of 821 patients already prescribed antihypertensive medication, 59% were achieving target BPs. Data on low-density lipoprotein (LDL) cholesterol levels were not available for 53% of the 2175 patients who should have had lipid screening according to the guidelines. Of 624 patients not prescribed a statin, treatment was indicated for 41%. Of 368 already prescribed a statin, 62% were achieving target LDL cholesterol levels. Sufficient data for calculation of absolute risk had been recorded for 74% of the 1736 patients for whom such calculation was recommended by the guidelines. The remaining 26% either had at least one required variable unmeasured (20%) or missing from the data collection (6%). For those at high absolute CVD risk (without established disease) and those with established CVD, 23% and 53%, respectively, had been prescribed both antihypertensive medication and a statin.

Conclusions: Gaps between guideline recommendations and practice in recording and managing BP were relatively low compared with gaps for lipids. When stratified by absolute risk, patients at high risk of a cardiovascular event were found to be substantially undertreated.

  • Ruth J Webster1
  • Emma L Heeley1
  • David P Peiris1
  • Clare Bayram2
  • Alan Cass1,3,4
  • Anushka A Patel1

  • 1 The George Institute for International Health, University of Sydney, Sydney, NSW.
  • 2 Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW.
  • 3 Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW.
  • 4 Faculty of Medicine, University of Sydney, Sydney, NSW.

Correspondence: rwebster@george.org.au

Acknowledgements: 

We wish to thank the participating GPs for their generosity. We also thank Peter Arnold for his extensive editorial comment on the manuscript and Helena Britt for her editorial input. Anushka Patel was supported by an NHF Career Development Award, David Peiris by a New South Wales Clinical Excellence Commission scholarship, and Alan Cass by an NHMRC Senior Research Fellowship.

Competing interests:

During the data collection period of our substudy, the BEACH program was funded by the National Prescribing Service, AstraZeneca, Janssen-Cilag, Merck Sharp & Dohme, Pfizer, Abbott and Sanofi-Aventis.

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