Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: findings from the Kanyini Audit

Abstract

Objective: To describe cardiovascular disease (CVD) risk management in Indigenous primary health care. Design, setting and participants: Review of 1165 randomly selected case records of Indigenous Australian adults, aged ≥ 18 years, regularly attending eight health services in diverse settings in New South Wales, Queensland and Central Australia, October 2007 – May 2008. Main outcome measure: Adherence to CVD risk screening and management guidelines, especially with respect to overall or absolute CVD risk. Results: More than half the people in the sample (53%) were not adequately screened for CVD risk according to national recommendations. Underscreening was significantly associated with younger age, less frequent attendance, and lower uptake of the Medicare Health Assessment. Of the sample, 9% had established CVD, and 29% of those aged ≥ 30 years were classified as high risk according to the 2004 National Heart Foundation of Australia (NHFA) adjusted Framingham equation. Of those with CVD, 40% (95% CI, 30%–50%) were not prescribed a combination of blood pressure (BP) medicines, statins and antiplatelet agents, and 56% (95% CI, 49%–62%) of high‐risk individuals without CVD were not prescribed BP medicines and statins. For high‐risk individuals not prescribed BP medicines or statins, 74% (95% CI, 64%–84%) and 30% (95% CI, 23%–39%) respectively, did not meet 2004 NHFA criteria for prescribing of these medications, and of those already prescribed BP medicines or statins, 41% (95% CI, 36%–47%) and 59% (95% CI, 52%–66%) did not meet respective guideline targets. Conclusions: These management gaps are similar to those found in non‐Indigenous health care settings, suggesting deficiencies across the health system. Prescribing guidelines which exclude many high‐risk individuals contribute to suboptimal management. Guideline reform and improved health service capacity could substantially improve Indigenous vascular health.

Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study

“…Nevertheless, the age profile of the population closely reflects that of the overall Indigenous population in Central Australia. Likewise, as noted earlier, our results for the prevalence of CAD and diabetes are similar to findings of other studies in Indigenous Australian communities where medical record review was used for the whole community 28 29. Other comorbidities may have contributed to the development of HF (eg, sleep apnoea) but these are difficult to assess in Central Australia and are not included in this work.…”

“…National data are self-reported, however, and other researchers have noted similar rates of disease in Indigenous populations. For example, Peiris et al observed 9% CAD in 1200 Indigenous primary care patients,28 and 5% CAD was reported in the Strong Heart Study 21. Likewise, similar high diabetes rates were reported by O'Dea et al (52.4% in an older Indigenous population29) and Devereux et al (51% in an American Indian population21).…”

Evidence for low high-density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review

“…Most studies had a strong regional focus; 8 of 15 were conducted in single rural or remote communities in the Northern Territory. One national survey included participants from medical practices in capital cities and from remote communities [33] and two urban surveys were carried out in metropolitan capital cities [34,35]. Six of the 15 studies presented HDL-C data in separate groups according to age, but where a mean overall age was reported, this ranged only between 29.9-40 years, for both males and females.…”

“…Only three studies had fewer females than males: 39% [9]; 48% [36]; and 49% [32], while in all other studies the proportion of females ranged from 54-86%. Although some study response rates were low (down to 14%) [34,35], six of 15 studies reported response rates ≥ 80% [9,23,33,37-39] and one study reported response rates of between 57-97%, depending on survey year [22]. Two studies did not report a response rate [20,24] and in another, data were retrieved from medical records so that a community response rate was not applicable [33].…”

“…Although some study response rates were low (down to 14%) [34,35], six of 15 studies reported response rates ≥ 80% [9,23,33,37-39] and one study reported response rates of between 57-97%, depending on survey year [22]. Two studies did not report a response rate [20,24] and in another, data were retrieved from medical records so that a community response rate was not applicable [33]. Another study reported male and female response rates separately; these varied from 53% (males, 1995) to 96% (females, 1989) [22].…”