Edwina Wing-Lun, Simone Marschner, Desi Quintans, Sean Taylor, Jakelin Troy, Clara Chow, Sarah Zaman
{"title":"Secondary prevention of coronary heart disease in Aboriginal and Torres Strait Islander people in primary care.","authors":"Edwina Wing-Lun, Simone Marschner, Desi Quintans, Sean Taylor, Jakelin Troy, Clara Chow, Sarah Zaman","doi":"10.1111/imj.70025","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Coronary heart disease (CHD) is the primary cause of mortality in Australia and the largest contributor to the 'gap' in cardiovascular disease deaths between Aboriginal and Torres Strait Islander (First Nations) people and non-indigenous Australians.</p><p><strong>Aim: </strong>To assess secondary prevention of CHD in First Nations people in primary care in Australia.</p><p><strong>Methods: </strong>Retrospective cohort study of patients with CHD under active primary care management using electronic medical records from 406 general practices across Australia. Ultimately, 50 088 people with CHD were included in the study, and 3.5% of those were First Nations people. After 5.9 years (standard deviation 5.0) in primary care adjusting for gender, age, remoteness, comorbidities, smoking status and continuity of care, First Nations peoples received equal statin (adjusted odds ratio (aOR): 0.9; 95% CI:0.8-1.1, P = 0.28), angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (aOR:1.0; 95% CI:0.9-1.2, P = 0.85) and beta blockers (aOR:0.9;95% CI:0.8-1.1, P = 0.41) prescriptions. First Nations peoples were more likely to achieve BP <1.8 in similar proportions (35.2% vs 36.9%, P = 0.16) but less likely to have HDL-C >1.0 mmol/L (57.5% vs 73.7%, P < 0.001), triglycerides<2.0 mmol/L (61.7% vs 76.0%, P < 0.001) and HbA1C ≤ 53 mmol/mol (7.0%) (67.7% vs 82.1%, P < 0.001). A higher proportion of First Nations people had HbA1c measured (75.7% vs 66.6%, P < 0.001).</p><p><strong>Conclusion: </strong>First Nations peoples with CHD under active primary care management received similar secondary prevention medications and achieved BP and LDL-C targets as frequently as non-indigenous Australians. A focus on easier access to facilitate attending primary care is needed to close the gap as well as addressing social determinants of health and structural inequities.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal Medicine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/imj.70025","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Coronary heart disease (CHD) is the primary cause of mortality in Australia and the largest contributor to the 'gap' in cardiovascular disease deaths between Aboriginal and Torres Strait Islander (First Nations) people and non-indigenous Australians.
Aim: To assess secondary prevention of CHD in First Nations people in primary care in Australia.
Methods: Retrospective cohort study of patients with CHD under active primary care management using electronic medical records from 406 general practices across Australia. Ultimately, 50 088 people with CHD were included in the study, and 3.5% of those were First Nations people. After 5.9 years (standard deviation 5.0) in primary care adjusting for gender, age, remoteness, comorbidities, smoking status and continuity of care, First Nations peoples received equal statin (adjusted odds ratio (aOR): 0.9; 95% CI:0.8-1.1, P = 0.28), angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (aOR:1.0; 95% CI:0.9-1.2, P = 0.85) and beta blockers (aOR:0.9;95% CI:0.8-1.1, P = 0.41) prescriptions. First Nations peoples were more likely to achieve BP <1.8 in similar proportions (35.2% vs 36.9%, P = 0.16) but less likely to have HDL-C >1.0 mmol/L (57.5% vs 73.7%, P < 0.001), triglycerides<2.0 mmol/L (61.7% vs 76.0%, P < 0.001) and HbA1C ≤ 53 mmol/mol (7.0%) (67.7% vs 82.1%, P < 0.001). A higher proportion of First Nations people had HbA1c measured (75.7% vs 66.6%, P < 0.001).
Conclusion: First Nations peoples with CHD under active primary care management received similar secondary prevention medications and achieved BP and LDL-C targets as frequently as non-indigenous Australians. A focus on easier access to facilitate attending primary care is needed to close the gap as well as addressing social determinants of health and structural inequities.
背景:冠心病(CHD)是澳大利亚死亡的主要原因,也是土著和托雷斯海峡岛民(第一民族)与非土著澳大利亚人之间心血管疾病死亡“差距”的最大贡献者。目的:评估澳大利亚初级保健中原住民冠心病的二级预防。方法:采用澳大利亚406家全科医院的电子病历,对接受积极初级保健管理的冠心病患者进行回顾性队列研究。最终,50088名冠心病患者被纳入研究,其中3.5%是原住民。经过5.9年(标准差5.0)的初级保健调整性别、年龄、偏远、合并症、吸烟状况和护理的连续性后,原住民接受了相同的他汀类药物(调整优势比(aOR): 0.9;95% CI:0.8-1.1, P = 0.28),血管紧张素转换酶抑制剂/血管紧张素II受体拮抗剂(aOR:1.0;95% CI:0.9-1.2, P = 0.85)和受体阻滞剂(aOR:0.9;95% CI:0.8-1.1, P = 0.41)处方。原住民更有可能达到血压1.0 mmol/L (57.5% vs 73.7%)。结论:在积极的初级保健管理下,原住民冠心病患者接受了类似的二级预防药物治疗,达到血压和LDL-C目标的频率与非土著澳大利亚人相同。要缩小差距,并解决健康的社会决定因素和结构性不平等问题,就需要把重点放在更容易获得初级保健服务上。
期刊介绍:
The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.