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  • Comparing secondary prevention for patients with coronary heart disease and stroke attending Australian general practices: a cross-sectional study using nationwide electronic database

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Original research
Comparing secondary prevention for patients with coronary heart disease and stroke attending Australian general practices: a cross-sectional study using nationwide electronic database
  1. Jason Yue1,
  2. Samia Kazi1,2,
  3. Tu Nguyen1,
  4. Clara Kayei Chow1,2
  1. 1 Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Professor Clara Kayei Chow, Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia; clara.chow{at}sydney.edu.au

Abstract

Objectives To compare secondary prevention care for patients with coronary heart disease (CHD) and stroke, exploring particularly the influences due to frequency and regularity of primary care visits.

Setting Secondary prevention for patients (≥18 years) in the National Prescription Service administrative electronic health record database collated from 458 Australian general practice sites across all states and territories.

Design Retrospective cross-sectional and panel study. Patient and care-level characteristics were compared for differing CHD/stroke diagnoses. Associations between the type of cardiovascular diagnosis and medication prescription as well as risk factor assessment were examined using multivariable logistic regression.

Participants Patients with three or more general practice encounters within 2 years of their latest visit during 2016–2020.

Outcome measures Proportions and odds ratios (ORs) for (1) prescription of antihypertensives, antilipidaemics and antiplatelets and (2) assessment of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) in patients with stroke only compared against those with CHD only and those with both conditions.

Results There were 111 892 patients with CHD only, 27 863 with stroke only and 9791 with both conditions. Relative to patients with CHD, patients with stroke were underprescribed antihypertensives (70.8% vs 82.8%), antilipidaemics (63.1% vs 78.7%) and antiplatelets (42.2% vs 45.7%). With sociodemographic factors, comorbidities and level of care considered as covariates, the odds of non-prescription of any recommended secondary prevention medications were higher in patients with stroke only (adjusted OR 1.37; 95% CI (1.31, 1.44)) compared with patients with CHD only. Patients with stroke only were also more likely to have neither BP nor LDL-C monitored (adjusted OR 1.26; 95% CI (1.18, 1.34)). Frequent and regular general practitioner encounters were independently associated with the prescription of secondary prevention medications (p<0.001).

Conclusions Secondary prevention management is suboptimal in cardiovascular disease patients and worse post-stroke compared with post-CHD. More frequent and regular primary care encounters were associated with improved secondary prevention.

  • primary care
  • general practice
  • standards of care
  • pharmacoepidemiology
  • evidence-based medicine

Data availability statement

Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/bmjqs-2022-015699

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Contributors JY conducted the analysis and drafted the manuscript as the guarantor of the study and CC controlled the decision to publish. The overall study protocol and ethics to obtain data was led by CC. The current analysis plan was co-designed by JY and CC. All authors collaboratively provided comments and edited iterative versions of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CC reports grants from the National Health and Medical Research Council and National Heart Foundation of Australia, outside the submitted work; JY reports that this work was submitted towards the requirements of the degree of Doctor of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.