Quality of cardiovascular disease care in Ontario’s primary care practices: a cross sectional study examining differences in guideline adherence by patient sex

Abstract

BackgroundWomen are disproportionately affected by cardiovascular disease, often experiencing poorer outcomes following a cardiovascular event. Evidence points to inequities in processes of care as a potential contributing factor. This study sought to determine whether any sex differences exist in adherence to process of care guidelines for cardiovascular disease within primary care practices in Ontario, Canada.MethodsThis is a secondary analysis of pooled cross-sectional baseline data collected through a larger quality improvement initiative known as the Improved Delivery of Cardiovascular Care (IDOCC). Chart abstraction was performed for 4,931 patients from 84 primary care practices in Eastern Ontario who had, or were at high risk of, cardiovascular disease. Measures examining adherence to guidelines associated with nine areas of cardiovascular care (coronary artery disease, peripheral vascular disease (PVD), stroke/transient ischemic attack, chronic kidney disease, diabetes, dyslipidemia, hypertension, smoking cessation, and weight management) were collected. Multivariable logistic regression analysis was performed to evaluate sex differences, adjusting for age, physician remuneration, and rurality.ResultsWomen were significantly less likely to have their lipid profiles taken (OR = 1.17, 95% CI 1.03-1.33), be prescribed lipid lowering medication for dyslipidemia (OR = 1.54, 95% CI 1.20-1.97), and to be prescribed ASA following stroke (OR = 1.56, 95% CI 1.39-1.75). Women with PVD were significantly less likely to be prescribed ACE inhibitors and/or angiotensin receptor blockers (OR = 1.74, 95% CI 1.25-2.41) and lipid lowering medications (OR = 1.95, 95% CI 1.46-2.62) or ASA (OR = 1.59, 95% CI 1.43-1.78). However, women were more likely to have two blood pressure measurements taken and to be referred to a dietician or weight loss program. Male patients with diabetes were less likely to be prescribed glycemic control medication (OR = 0.84, 95% CI 0.74-0.86).ConclusionsSex disparities exist in the quality of cardiovascular care in Canadian primary care practices, which tend to favour men. Women with PVD have a particularly high risk of not receiving appropriate medications. Our findings indicate that improvements in care delivery should be made to address these issues, particularly with regard to the prescribing of recommended medications for women, and preventive measures for men.

Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS)

“…We identified sex disparities in achievement of CV treatment targets that are consistent with those seen in other cohorts [8][9][10]. Following publication of CV disease prevention guidelines specific to women [11], improved awareness of CV risk [12] and a one-third drop in age-adjusted death rates from coronary heart disease have been documented [13,14]; however, CV disease still outranks cancer, chronic lower respiratory disease, Alzheimer's disease and accidents for cause of death [15], and CV death rates in women aged 35-54 years are rising, presumably related to increasing rates of diabetes and obesity [14].…”

Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science

“…176 Disparities exist in regards to physician adherence to evidence based guidelines in the treatment of CVD and prescribing patterns have shown that women are less likely to be prescribed lipid lowering medications, antiplatelet agents, and beta-blockers at the time of hospital discharge than men. 290–293 Hospitals participating in AHA Get With the Guidelines-CAD program have had increased rates of guideline adherence over a 5 year period regardless of gender and age. 294 This demonstrates the powerful impact quality improvement projects can have upon adherence, yet more data are necessary to determine if it will effect clinical outcomes.…”

Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

“…We focused on variation across these variables because age and gender disparities in quality of care have been described previously for chronic kidney disease and other related conditions. [31][32][33][34][35] We were also interested to see if there were changes over time. Finally, quality of care indicators for chronic kidney disease have been shown to vary based on chronic kidney disease stage.…”