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Cardiovascular Disease Risk Prediction for Aboriginal Populations in Central Australia
S156
Abstracts
ABSTRACTS
INDIGENOUS 369 Evaluation of the First 12 Months of a Cardiovascular Disease (CVD) Risk Assessment and Treatment Program at T¯amaki Healthcare Primary Health Organisation, Auckland, New Zealand David Peiris 1,∗ , Jonathan Murray 2 , Doreen Scully 2 , Virantha Tilakawardane 2 , Lorraine Hetaraka-Stevens 2 , Anushka Patel 1 1 The George Institute for International Health, NSW, Australia; 2 Tamaki
Healthcare Primary Health Organisation, Auckland, New Zealand
With the recent advent of CVD risk assessment programs we examined the risk profile and management practices for the first 1420 people to have undergone an ¯ electronic CVD risk assessment at Tamaki HealthCare Primary Health Organisation (PHO) in 2007. Methods: An electronic audit of CVD risk assessment and medication data was conducted at fourteen PHO practices, supplemented by a manual clinic record review of highrisk patients. The NZ guidelines-adjusted Framingham equation was used to calculate risk. Results: The mean age was 55.4 (54.8–55.9) years, (55.7% ¯ male and 44.3% female). Both Maori males, OR 1.76 (1.08–2.86) p = 0.02, and females, OR 1.82 (1.02–3.23) p = 0.04, were significantly more likely to be at high CVD risk (five year risk >15%) than NZ European/Others. There were no significant differences in risk profile between Pacifica people and NZ European/Others. In total 194 (13.7%) people had a 5-year CVD risk >15% and 224 (15.8%) people had established CVD. Medication data was available for 399 (95.5%) people from these two high-risk groups. Prescribing rates were 76.7% (72.5–80.8%) for blood pressure lowering, 71.7% (67.2–76.1%) for lipid lowering and 63.9% (59.2–68.6%) for anti-platelet therapies in these two groups. For 471 people with either diabetes or established CVD 66.4% (62.2–70.7%) and 66.6% (62.4–70.9%) were not achieving NZ recommendations for target blood pressure and lipid levels, respectively. Conclusion: Despite nationally endorsed absolute risk based guidelines significant evidence-practice gaps were encountered in this study. Several PHO initiatives (including audit-feedback reporting cycles from this program) are underway to address these gaps. doi:10.1016/j.hlc.2008.05.370
Heart, Lung and Circulation 2008;17S:S1–S209
370 Cardiovascular Disease Risk Prediction for Aboriginal Populations in Central Australia Alex Brown 1,∗ , Iris Roberts 1 , Joseph Fitz 2 , Stacey Svenson 1 , Zaimin Wang 3 , Kevin Rowley 4 1 Baker Heart Research Institute, Alice Springs, NT, Australia; 2 Menzies School of Health Research, Darwin, NT, Australia; 3 University of Queensland, Brisbane, QLD, Australia; 4 Onemda VicHealth Koori Health Unit, University of Melbourne, Melbourne, VIC, Australia
Background: Identification of persons at high risk of cardiovascular disease (CVD) events conventionally makes use of age, sex, blood pressure, smoking and diabetes status, and plasma lipids. Aboriginal people in central Australia have a lipid profile unlike mainstream populations, with lower total cholesterol and extremely low levels of HDL cholesterol. Elevated blood pressure, diabetes and, for men, smoking occur with high prevalence, as does chronic kidney disease. We aimed to identify predictors of cardiovascular events for Aboriginal people from communities in central Australia. Methods: A community-based cohort of 358 persons aged 25–74 years and free of known coronary heart disease or stroke at baseline were followed up over a 10-year period. Evidence of CVD events (myocardial infarction, angina, coronary heart disease death, stroke or transient ischaemic attack) was sought from hospital, primary health care and death records. Results: There were 27 confirmed incident events: acute myocardial infarction (9), angina/coronary artery disease (7), stroke/transient ischaemic attack (11); confirmed event rate was 850/100,000 person years. The major predictors of incident cardiovascular events were blood pressure, diabetes and smoking. Total:HDL cholesterol ratio was almost universally elevated and was not a good discriminator for CVD risk in this population, nor was total cholesterol level a significant predictor of CVD events. Conclusion: Risk prediction algorithms are under investigation to assess their utility for use in central Australia. doi:10.1016/j.hlc.2008.05.371 371 Cardiac Surgical Outcomes in Indigenous Australians: The Flinders Medical Centre Registry Sam Lehman 1,∗ , Rob Baker 1 , Philip Aylward 1 , Hugh Cullen 1 , Stephen Worthley 2 , John Knight 1 , Derek Chew 1 1 Flinders Medical Centre, Adelaide, South Australia, Australia; 2 Royal Adelaide Hospital, Adelaide, South Australia, Australia
Background: The indigenous population of Australia experience high rates of premature coronary artery and heart valve disease, however outcomes following cardiac procedures have not been well described .We studied 30-day and long-term outcomes of indigenous patients following cardiac surgery. Patients and methods: We prospectively collected clinical, operative and post-operative event data for consecu-
Abstracts
ABSTRACTS
INDIGENOUS 369 Evaluation of the First 12 Months of a Cardiovascular Disease (CVD) Risk Assessment and Treatment Program at T¯amaki Healthcare Primary Health Organisation, Auckland, New Zealand David Peiris 1,∗ , Jonathan Murray 2 , Doreen Scully 2 , Virantha Tilakawardane 2 , Lorraine Hetaraka-Stevens 2 , Anushka Patel 1 1 The George Institute for International Health, NSW, Australia; 2 Tamaki
Healthcare Primary Health Organisation, Auckland, New Zealand
With the recent advent of CVD risk assessment programs we examined the risk profile and management practices for the first 1420 people to have undergone an ¯ electronic CVD risk assessment at Tamaki HealthCare Primary Health Organisation (PHO) in 2007. Methods: An electronic audit of CVD risk assessment and medication data was conducted at fourteen PHO practices, supplemented by a manual clinic record review of highrisk patients. The NZ guidelines-adjusted Framingham equation was used to calculate risk. Results: The mean age was 55.4 (54.8–55.9) years, (55.7% ¯ male and 44.3% female). Both Maori males, OR 1.76 (1.08–2.86) p = 0.02, and females, OR 1.82 (1.02–3.23) p = 0.04, were significantly more likely to be at high CVD risk (five year risk >15%) than NZ European/Others. There were no significant differences in risk profile between Pacifica people and NZ European/Others. In total 194 (13.7%) people had a 5-year CVD risk >15% and 224 (15.8%) people had established CVD. Medication data was available for 399 (95.5%) people from these two high-risk groups. Prescribing rates were 76.7% (72.5–80.8%) for blood pressure lowering, 71.7% (67.2–76.1%) for lipid lowering and 63.9% (59.2–68.6%) for anti-platelet therapies in these two groups. For 471 people with either diabetes or established CVD 66.4% (62.2–70.7%) and 66.6% (62.4–70.9%) were not achieving NZ recommendations for target blood pressure and lipid levels, respectively. Conclusion: Despite nationally endorsed absolute risk based guidelines significant evidence-practice gaps were encountered in this study. Several PHO initiatives (including audit-feedback reporting cycles from this program) are underway to address these gaps. doi:10.1016/j.hlc.2008.05.370
Heart, Lung and Circulation 2008;17S:S1–S209
370 Cardiovascular Disease Risk Prediction for Aboriginal Populations in Central Australia Alex Brown 1,∗ , Iris Roberts 1 , Joseph Fitz 2 , Stacey Svenson 1 , Zaimin Wang 3 , Kevin Rowley 4 1 Baker Heart Research Institute, Alice Springs, NT, Australia; 2 Menzies School of Health Research, Darwin, NT, Australia; 3 University of Queensland, Brisbane, QLD, Australia; 4 Onemda VicHealth Koori Health Unit, University of Melbourne, Melbourne, VIC, Australia
Background: Identification of persons at high risk of cardiovascular disease (CVD) events conventionally makes use of age, sex, blood pressure, smoking and diabetes status, and plasma lipids. Aboriginal people in central Australia have a lipid profile unlike mainstream populations, with lower total cholesterol and extremely low levels of HDL cholesterol. Elevated blood pressure, diabetes and, for men, smoking occur with high prevalence, as does chronic kidney disease. We aimed to identify predictors of cardiovascular events for Aboriginal people from communities in central Australia. Methods: A community-based cohort of 358 persons aged 25–74 years and free of known coronary heart disease or stroke at baseline were followed up over a 10-year period. Evidence of CVD events (myocardial infarction, angina, coronary heart disease death, stroke or transient ischaemic attack) was sought from hospital, primary health care and death records. Results: There were 27 confirmed incident events: acute myocardial infarction (9), angina/coronary artery disease (7), stroke/transient ischaemic attack (11); confirmed event rate was 850/100,000 person years. The major predictors of incident cardiovascular events were blood pressure, diabetes and smoking. Total:HDL cholesterol ratio was almost universally elevated and was not a good discriminator for CVD risk in this population, nor was total cholesterol level a significant predictor of CVD events. Conclusion: Risk prediction algorithms are under investigation to assess their utility for use in central Australia. doi:10.1016/j.hlc.2008.05.371 371 Cardiac Surgical Outcomes in Indigenous Australians: The Flinders Medical Centre Registry Sam Lehman 1,∗ , Rob Baker 1 , Philip Aylward 1 , Hugh Cullen 1 , Stephen Worthley 2 , John Knight 1 , Derek Chew 1 1 Flinders Medical Centre, Adelaide, South Australia, Australia; 2 Royal Adelaide Hospital, Adelaide, South Australia, Australia
Background: The indigenous population of Australia experience high rates of premature coronary artery and heart valve disease, however outcomes following cardiac procedures have not been well described .We studied 30-day and long-term outcomes of indigenous patients following cardiac surgery. Patients and methods: We prospectively collected clinical, operative and post-operative event data for consecu-