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Gender disparities in the assessment and management of cardiovascular risk in primary care: The AusHEART study

Turnbull, Fiona, Arima, Hisatomi, Heeley, Emma, Cass, Alan, Chalmers, John, Morgan, Claire, Patel, Anushka, Peiris, David, Weekes, Andrew and Anderson, Craig (2011). Gender disparities in the assessment and management of cardiovascular risk in primary care: The AusHEART study. European Journal of Cardiovascular Prevention and Rehabilitation,18(3):498-503.

Document type: Journal Article

IRMA ID 84473293xPUB51
Title Gender disparities in the assessment and management of cardiovascular risk in primary care: The AusHEART study
Author Turnbull, Fiona
Arima, Hisatomi
Heeley, Emma
Cass, Alan
Chalmers, John
Morgan, Claire
Patel, Anushka
Peiris, David
Weekes, Andrew
Anderson, Craig
Journal Name European Journal of Cardiovascular Prevention and Rehabilitation
Publication Date 2011
Volume Number 18
Issue Number 3
ISSN 1350-6277   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-79959202888
Start Page 498
End Page 503
Total Pages 5
Place of Publication United Kingdom
Publisher Sage Publications Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Aims: Studies indicate ongoing gender-based differences in the prevention, detection and management of cardiovascular disease. The aims of this study were to determine whether there are differences in general practitioners’ (GPs’) perceptions of a patient’s cardiovascular risk compared with the patient’s estimated risk and in the patient’s subsequent medical management according to patient sex.

Methods: The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey among 322 GPs. Each GP was asked to collect data on cardiovascular disease risk factors and their management in 15–20 consecutive patients (age ≥55 years) who presented between April and June, 2008. They were also asked to estimate each patient’s absolute risk of a cardiovascular event in the next five years. The main outcomes were the Adjusted Framingham risk, GP estimated risk and proportion of patients receiving blood pressure-lowering, statin and antiplatelet therapy.

Results: A total of 5293 patients were recruited to the study, of whom 2968 (56%) were women. Among patients without established cardiovascular disease, the level of agreement between the GP estimated risk and the Adjusted Framingham risk was poor (<50%) and was similarly so for men (kappa coefficient 0.18; 95% confidence interval (CI) 0.14–0.21) and women (0.19; 95% CI 0.16–0.22; P homogeneity = 0.57). For patients with established cardiovascular disease, however, women were more likely to be assigned by the GP to a lower risk category (66% vs. 54%, P < 0.001) and less likely to be prescribed combination (blood pressure-lowering, statin and antiplatelet) (44% vs. 56%, P < 0.001) therapy compared with men, even after adjusting for patient age.

Conclusions: Cardiovascular risk is underrecognized and undertreated in Australian primary care patients, with women apparently disproportionately affected. These findings underscore the importance of initiatives to raise awareness of cardiovascular disease in women.
DOI http://dx.doi.org/10.1177/1741826710389369   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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