Potentially preventable medication-related hospitalisations with cardiovascular disease of Aboriginal and Torres Strait Islander people, Queensland, 2013-2017: a retrospective cohort study.

Abstract

Objective: To identify the proportion of hospitalisations (inpatient admissions and emergency department presentations) of Aboriginal and Torres Strait Islander people in Queensland that were medication-related and potentially preventable for nine clinical indicators of cardiovascular disease (CVD).

Study design: Retrospective cohort study; analysis of linked hospitalisations and emergency department presentations data and administrative records of medical services, pharmaceuticals, and deaths.

Setting, participants: Aboriginal or Torres Strait Islander adults (18 years or older) admitted to Queensland public and private hospitals, 1 January 2013 - 31 December 2017.

Main outcome measures: Potentially preventable medication-related hospitalisations (PPMRHs), defined by a set of clinical indicators describing CVD; deaths within 30 days of PPMRHs; hospital costs.

Results: We identified 31 472 CVD-related hospitalisations, of which 11 469 were of people with medical histories suggesting harm that was foreseeable and preventable with appropriate treatment. Of the 7886 hospitalisations with congestive heart failure, 4350 (55%) were of people with prior CVD diagnoses; 681 (16%) were associated with use of medicines known to exacerbate congestive heart failure, and 1488 (34%) were associated with underuse of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors. Of the 1089 hospitalisations with myocardial infarction of people who had previously experienced myocardial infarction or acute coronary syndrome events, 809 (74%) were not receiving recommended treatment at the time of hospitalisation. Of the 5417 hospitalisations with ischaemic events of people with histories including diabetes and earlier ischaemic events, 3343 (62%) were not receiving antiplatelet or lipid-lowering therapy. The median cost associated with PPMRHs for the time period (2013-2017) was $4352 (interquartile range, $8742), and 136 (3%) of CVD-related deaths within 30 days of hospital discharge followed PPMRH events.

Conclusions: Interventions supporting targeted and timely medication safety services for Aboriginal and Torres Strait Islander people need to be reviewed and improved to reduce the numbers of avoidable hospitalisations and deaths.