Factors related to under‐treatment of secondary cardiovascular risk, including primary healthcare: Australian National Health Survey linked data analysis

Abstract

Objective: To inform national evidence gaps on cardiovascular disease (CVD) preventive medication use and factors relating to under‐treatment ‐ including primary healthcare engagement ‐ among CVD survivors in Australia. Methods: Data from 884 participants with self‐reported CVD from the 2014–15 National Health Survey were linked to primary care and pharmaceutical dispensing data for 2016 through the Multi‐Agency Data Integration Project. Logistic regression quantified the relation of combined blood pressure‐ and lipid‐lowering medication use to participant characteristics. Results: Overall, 94.8% had visited a general practitioner (GP) and 40.0% were on both blood pressure‐ and lipid‐lowering medications. Medication use was least likely in: women versus men (OR=0.49[95%CI:0.37‐0.65]), younger participants (e.g. 45–64y versus 65–85y: OR=0.58[0.42–0.79])and current versus never‐smokers (OR=0.73[0.44–1.20]). Treatment was more likely in those with ≥9 versus ≤4 conditions (OR=2.15[1.39–3.31]), with ≥11 versus 0–2 GP visits/year (OR=2.62[1.53–4.48]) and with individual CVD risk factors (e.g. high blood pressure OR=3.13 [2.34–4.19]) versus without); the latter even accounting for GP service‐use frequency. Conclusions: Younger people, smokers, those with infrequent GP visits or without CVD risk factors were the least likely to be on medication. Implications for public health: Substantial under‐treatment, even among those using GP services, indicates opportunities to prevent further CVD events in primary care.