Disparities between prescribing of secondary prevention therapies for stroke and coronary artery disease in general practice

Emma Heeley, Craig Anderson, Anushka Patel, Alan Cass, David Peiris, Andrew Weekes, John Chalmers

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Extensive evidence exists regarding the effectiveness of secondary prevention measures in patients with cardiovascular disease.

Aim: We aimed to examine the management and risk perceptions of cardiovascular events in people with established cardiovascular disease.

Methods: 
We analyzed data on 1453 patients, ≥55 year old, with a history of cardiovascular disease, from the Australian Hypertension and Absolute Risk Study.

Results: Compared with those 533 patients with stroke/transient ischemic attack, the 743 patients with coronary artery disease were twice as likely to have been prescribed secondary prevention therapies even after adjustment for potential confounding variables (adjusted relative risks 1·85; 95% confidence interval 1·56–2·19, 42% vs. 73% for use of the combination of blood pressure-lowering, lipid-lowering and antiplatelet therapies) and to have better control of lipid and blood pressure levels. General practitioners estimated that only 27% of patients with stroke/transient ischemic attack – 38% of those with coronary artery disease and 41% of those with both conditions – were at a high risk (≥15%) of a recurrent event. Patients similarly underestimated their risk of recurrent cardiovascular events, with only 8% of stroke/transient ischemic attack, 11% of coronary and 15% of combination disease patients rating themselves at ‘high’ or ‘very-high’ risk.

Conclusions: This study reaffirms the large treatment gap in the uptake of secondary prevention for cardiovascular disease in primary care settings, being much greater for patients with cerebral compared with cardiac cardiovascular disease. This appears to be related to differential perceptions of cardiovascular risk across different vascular territories in both patients and doctors.
Original languageEnglish
Pages (from-to)649-654
Number of pages6
JournalInternational Journal of Stroke
Volume7
Issue number8
DOIs
Publication statusPublished - 1 Dec 2012

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Secondary Prevention
General Practice
Coronary Artery Disease
Stroke
Cardiovascular Diseases
Transient Ischemic Attack
Therapeutics
Blood Pressure
Lipids
Confounding Factors (Epidemiology)
Risk Management
General Practitioners
Blood Vessels
Heart Diseases
Primary Health Care
Confidence Intervals
Hypertension

Cite this

Heeley, Emma ; Anderson, Craig ; Patel, Anushka ; Cass, Alan ; Peiris, David ; Weekes, Andrew ; Chalmers, John. / Disparities between prescribing of secondary prevention therapies for stroke and coronary artery disease in general practice. In: International Journal of Stroke. 2012 ; Vol. 7, No. 8. pp. 649-654.
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abstract = "Background: Extensive evidence exists regarding the effectiveness of secondary prevention measures in patients with cardiovascular disease.Aim: We aimed to examine the management and risk perceptions of cardiovascular events in people with established cardiovascular disease.Methods: We analyzed data on 1453 patients, ≥55 year old, with a history of cardiovascular disease, from the Australian Hypertension and Absolute Risk Study.Results: Compared with those 533 patients with stroke/transient ischemic attack, the 743 patients with coronary artery disease were twice as likely to have been prescribed secondary prevention therapies even after adjustment for potential confounding variables (adjusted relative risks 1·85; 95{\%} confidence interval 1·56–2·19, 42{\%} vs. 73{\%} for use of the combination of blood pressure-lowering, lipid-lowering and antiplatelet therapies) and to have better control of lipid and blood pressure levels. General practitioners estimated that only 27{\%} of patients with stroke/transient ischemic attack – 38{\%} of those with coronary artery disease and 41{\%} of those with both conditions – were at a high risk (≥15{\%}) of a recurrent event. Patients similarly underestimated their risk of recurrent cardiovascular events, with only 8{\%} of stroke/transient ischemic attack, 11{\%} of coronary and 15{\%} of combination disease patients rating themselves at ‘high’ or ‘very-high’ risk.Conclusions: This study reaffirms the large treatment gap in the uptake of secondary prevention for cardiovascular disease in primary care settings, being much greater for patients with cerebral compared with cardiac cardiovascular disease. This appears to be related to differential perceptions of cardiovascular risk across different vascular territories in both patients and doctors.",
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Disparities between prescribing of secondary prevention therapies for stroke and coronary artery disease in general practice. / Heeley, Emma; Anderson, Craig; Patel, Anushka; Cass, Alan; Peiris, David; Weekes, Andrew; Chalmers, John.

In: International Journal of Stroke, Vol. 7, No. 8, 01.12.2012, p. 649-654.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - Background: Extensive evidence exists regarding the effectiveness of secondary prevention measures in patients with cardiovascular disease.Aim: We aimed to examine the management and risk perceptions of cardiovascular events in people with established cardiovascular disease.Methods: We analyzed data on 1453 patients, ≥55 year old, with a history of cardiovascular disease, from the Australian Hypertension and Absolute Risk Study.Results: Compared with those 533 patients with stroke/transient ischemic attack, the 743 patients with coronary artery disease were twice as likely to have been prescribed secondary prevention therapies even after adjustment for potential confounding variables (adjusted relative risks 1·85; 95% confidence interval 1·56–2·19, 42% vs. 73% for use of the combination of blood pressure-lowering, lipid-lowering and antiplatelet therapies) and to have better control of lipid and blood pressure levels. General practitioners estimated that only 27% of patients with stroke/transient ischemic attack – 38% of those with coronary artery disease and 41% of those with both conditions – were at a high risk (≥15%) of a recurrent event. Patients similarly underestimated their risk of recurrent cardiovascular events, with only 8% of stroke/transient ischemic attack, 11% of coronary and 15% of combination disease patients rating themselves at ‘high’ or ‘very-high’ risk.Conclusions: This study reaffirms the large treatment gap in the uptake of secondary prevention for cardiovascular disease in primary care settings, being much greater for patients with cerebral compared with cardiac cardiovascular disease. This appears to be related to differential perceptions of cardiovascular risk across different vascular territories in both patients and doctors.

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