Is general practice identification of prior cardiovascular disease at the time of CVD risk assessment accurate and does it matter?

AIMS

To determine the accuracy of general practice recording of prior cardiovascular disease (CVD) at the time of CVD risk assessment and whether recording impacts on CVD management.

METHODS

Prior CVD status entered at the time of a first CVD risk assessment from 2002-2015 was compared to prior ischaemic CVD hospitalisations from national datasets using anonymous linkage with an encrypted National Health Index identifier. Clinical factors associated with inaccurate recording of prior events were identified using multivariable logistic regression. The impact of recording accuracy was assessed by the dispensing of CVD preventive medications in the six months after first CVD risk assessment.

RESULTS

Among 454,369 people aged 35-74 years who had CVD risk assessments, 30,924 (6.8%) had previously been admitted with ischaemic CVD. Of these people, only 61% were recorded as having prior CVD during risk assessment, with better recording for coronary and stroke events than for peripheral vascular procedures. Inaccurate primary care recording was more likely for younger people (<55 years), women, Māori, Pacific, Indian and Asian ethnic groups whereas smokers and people with diabetes were more likely to have prior CVD correctly identified. Over more than a decade, the odds of inaccurate recording during risk assessment increased [OR 1.09 (95% CIs 1.08-1.10)]. If prior CVD was entered at the time of risk assessment then dispensing of blood pressure-lowering, lipid-lowering, antiplatelet/anticoagulant medications, separately or together, was higher (86%, 85%, 83% and 69%, respectively) than if not recorded (70%, 60%, 60% and 43%).

CONCLUSIONS

Overall, 39% of people with prior CVD hospitalisations were not recorded as having prior CVD when their CVD risk was first assessed in general practice. This was associated with inequities in evidence-based risk management. System-based measures are required for robust data sharing at the time of clinical decision making.