Sue Wells

Aim: To investigate eGFR as an independent risk factor for CVD in a New Zealand primary care cohort, stratified by disease status (prior CVD, diabetes or no CVD or diabetes). Method: The PREDICT-CVD open cohort study is a large, ethnically diverse, New Zealand primary care cohort, generated by using a web-based CVD risk assessment tool. Using encrypted identifiers, participant profiles were linked anonymously to a regional laboratory database (to determine renal function) and to national hospitalisation and mortality datasets. Analyses using a single baseline eGFR measurement were undertaken in three clinical sub-cohorts of participants: those with prior CVD (n=29,742), with diabetes (n=44,416) and with neither CVD nor diabetes (n=192,696). The association between baseline eGFR (by category ≥90, 60-89.9, 30-59.9, and <30ml/min/1.73m2) and incident CVD was analysed with Kaplan Meier plots and Cox regression models. Results: After adjustment for traditional CVD risk factors, there was an inverse relationship between CVD risk and eGFR, up to an eGFR of 60ml/min/1.73m2 in all three clinical sub-cohorts, and up to an eGFR of 90ml/min/1.73m2 in the sub-cohort with CVD or diabetes. Compared to eGFR ≥90ml/min/1.73m2, the adjusted hazard ratios of a new CVD event for eGFR <30ml/min/1.73m2 in the CVD, diabetes and no CVD/no diabetes sub-cohorts were 2.29 (95% CI 2.00-2.61), 4.71 (3.92-5.67) and 2.78 (2.05-3.77), respectively. Compared to European/Other ethnic groups, Māori participants remained at greater adjusted risk of a new CVD event in all clinical sub-cohorts and Pacific people only in the no CVD/no diabetes sub-cohort, whereas Indian participants had a similar adjusted risk to European/Other, and Other Asian patients were consistently at lower adjusted risk. Sensitivity analyses for individuals with consecutive eGFR results (>90 days apart) yielded similar results. Conclusion: This study has confirmed that, in a large ethnically diverse primary care cohort, eGFR is a significant independent predictor of CVD risk, and the risk varies by ethnic group.

Aim: To estimate sociodemographic differences in the prevalence of coronary heart disease (CHD) in New Zealand from linked health records. Methods: We combined records of hospital treatment for CHD, dispensing of selected anti-anginal drugs and mortality to estimate the national point prevalence of coronary heart disease in New Zealand in December 2008. Stratified estimates are presented by gender; age; Māori, Pacific, Indian and 'Other' (mainly New Zealand European) ethnic groups; and socioeconomic status. Results: Among a "health contact" population of adults (greater than and equal to 15 years), about one in twenty (6.5% of men and 4.1% of women) had indicators of a past diagnosis or treatment for CHD or both. Substantial differences in prevalence occurred by gender, ethnic group and socioeconomic status. For example, among New Zealanders aged 35 to 74 years, Indian men had the highest age-adjusted prevalence (7.78%; 95%CI 7.43 to 8.15), almost double the prevalence of 'Other' males. Among women, Māori had the highest adjusted prevalence (4.03%; 95% CI 3.89 to 4.17), just over twice that of 'Others.' Conclusion: Major sociodemographic disparities in the national burden of CHD persist. Our results are similar to previous studies of ethnic disparities in CHD incidence, but also confirm concerns about the emerging CHD burden among South Asians. Indian males have the highest CHD prevalence of any gender-specific ethnic group. Of equal concern, Māori women have a similar prevalence to European males.

Background: Data on the cardiovascular disease risk profiles of Pacific peoples in New Zealand is usually aggregated and treated as a single entity. Little is known about the comparability or otherwise of cardiovascular disease (CVD) risk between different Pacific groups. Aim: To compare CVD risk profiles for the main Pacific ethnic groups assessed in New Zealand primary care practice to determine if it is reasonable to aggregate these data, or if significant differences exist. Methods: A web-based clinical decision support system for CVD risk assessment and management (PREDICT) has been implemented in primary care practices in nine PHOs throughout Auckland and Northland since 2002, covering approximately 65% of the population of these regions. Between 2002 and January 2009, baseline CVD risk assessments were carried out on 11,642 patients aged 35-74 years identifying with one or more Pacific ethnic groups (4933 Samoans, 1724 Tongans, 1366 Cook Island Maori, 880 Niueans, 1341 Fijians and 1398 people identified as Other Pacific or Pacific Not Further Defined). Fijians were subsequently excluded from the analyses because of a probable misclassification error that appears to combine Fijian Indians with ethnic Fijians. Prevalences of smoking, diabetes and prior history of CVD, as well as mean total cholesterol/HDL ratio, systolic and diastolic blood pressures, and Framingham 5-year CVD risk were calculated for each Pacific group. Age-adjusted risk ratios and mean differences stratified by gender were calculated using Samoans as the reference group. Results: Cook Island women were almost 60% more likely to smoke than Samoan women. While Tongan men had the highest proportion of smoking (29%) among Pacific men, Tongan women had the lowest smoking proportion (10%) among Pacific women. Tongan women and Niuean men and women had a higher burden of diabetes than other Pacific ethnic groups, which were 20-30% higher than their Samoan counterparts. Niuean men and women had lower blood pressure levels than all other Pacific groups while Tongan men and women had the highest total cholesterol to HDL ratios. Tongan men and women had higher absolute 5-year CVD risk scores, as estimated by the Framingham equation, than their Samoan counterparts (Age-adjusted mean differences 0.71% [95% CI 0.36% to 1.06%] for Tongan men and 0.52% [95% CI 0.17% to 0.86%] for Tongan women) although these risk differences were only about 10% higher in relative terms. Conclusion: The validity of the analyses depend on the assumption that the selection of participants for CVD risk assessment in primary care is similar between Pacific groups. The ethnic-specific CVD risk profiles presented do not represent estimates of population prevalence. Almost all previous Pacific data has been aggregated with Pacific peoples treated as a single entity because of small sample sizes. We have analysed data from the largest study to date measuring CVD risk factors in Pacific peoples living in New Zealand. Our findings suggest that aggregating Pacific population data appears to be reasonable in terms of assessing absolute CVD risk, however there are differences for specific CVD risk factors between Pacific ethnic groups that may be important for targeting community level interventions.

BackgroundDespite cardiovascular disease (CVD) risk prediction equations becoming more widely available for people aged ≥75 years, views of older people on CVD risk assessment are unknown.AimTo explore older people’s views on CVD risk prediction and its assessment.Design and settingQualitative study of community-dwelling older people in New Zealand.MethodA diverse group of older people was purposively recruited. Semi-structured interviews and focus groups were conducted, transcribed verbatim, and thematically analysed.ResultsThirty-nine participants (mean age 74 years) of Māori, Pacific, South Asian, and European ethnicities participated in one of 26 interviews or one of three focus groups. Three key themes emerged: poor knowledge and understanding of CVD and its risk assessment; acceptability and perceived benefit of knowing and receiving advice on managing personal CVD risk; and distinguishing between CVD outcomes — stroke and heart attack are not the same. Most participants did n...

Aim: To investigate the differences in the baseline cardiovascular disease (CVD) risk profiles of Pacific peoples and Europeans assessed in routine primary care practice by PREDICT, a web-based clinical decision support programme for assessing and managing CVD risk. Methods: PREDICT has been implemented in primary care practices from nine consenting PHOs in Auckland and Northland. Between 2002 and January 2009, over 70,000 CVD risk assessments were conducted. These analyses compare CVD risk factors for Pacific and European patients. Results: Baseline risk assessments were completed for 39,835 Europeans and 10,301 Pacific peoples aged 35-74 years. Over 85% of the Pacific cohort was comprised of the four main Pacific ethnic groups in New Zealand (Samoan, Tongan, Cook Island Maori and Niuean). Fijians (n=1341) were excluded from the analyses because of a likely misclassification error with Indian Fijians. On average, Pacific peoples in the PREDICT cohort were 4 years younger at the time of risk assessment than Europeans, and were overrepresented in areas of high socioeconomic deprivation. At risk assessment, Pacific men were 1.5 times as likely to be current smokers as European men, whereas similar or lower proportions of Pacific women smoked compared with European women. Pacific peoples were approximately three times more likely to have diabetes as Europeans. Pacific peoples had higher diastolic blood pressures and Pacific women had higher total cholesterol/HDL ratios. Both Pacific men and women had a significantly higher predicted risk of CVD in the next 5 years than Europeans, based on the Framingham risk score. Conclusions: The PREDICT programme has already generated the largest cohort of Pacific peoples ever to be studied in New Zealand. This comparative analysis of patients who have been screened highlights significant disparities in CVD risk factors for Pacific peoples particularly for diabetes in both sexes and for smoking in men. Targeting these modifiable risk factors will be important in addressing the widening inequalities in CVD outcomes between Pacific peoples and Europeans.

Aim: To compare the calibration performance of the original Framingham Heart Study risk prediction score for cardiovascular disease and an adjusted version of the Framingham score used in current New Zealand cardiovascular risk management guidelines for high and low risk ethnic groups. Methods: Since 2002 cardiovascular risk assessments have been undertaken as part of routine clinical care in many New Zealand primary care practices using PREDICT, a web-based decision support programme for assessing and managing cardiovascular risk. Individual risk profiles from PREDICT were electronically and anonymously linked to national hospital admissions and death registrations in January 2008. Calibration performance was investigated by comparing the observed 5-year cardiovascular event rates (deaths and hospitalisations) with predicted rates from the Framingham and New Zealand adjusted Framingham scores. Calibration was examined in a combined 'high risk' ethnic group (Maori, Pacific and Indian) and a European 'low risk' ethnic group. There was insufficient person-time follow-up for separate analyses in each ethnic group. The analyses were restricted to PREDICT participants aged 30-74 years with no history of previous cardiovascular disease. Results: Of the 59,344 participants followed for a mean of 2.11 years (125,064 person years of follow-up), 1,374 first cardiovascular events occurred. Among the 35,240 European participants, 759 cardiovascular events occurred during follow-up, giving a mean observed 5-year cumulative incidence of 4.5%. There were 582 events among the 21,026 Maori, Pacific and Indian participants, corresponding to a mean 5-year cumulative incidence rate of 7.4%. For Europeans, the original Framingham score overestimated 5-year risk by 0.7-3.2% at risk levels below 15% and by about 5% at higher risk levels. In contrast, for Maori, Pacific, and Indian patients combined, the Framingham score underestimated 5-year cardiovascular risk by 1.1-2.2% in participants who scored below 15% 5-year predicted risk (the recommended threshold for drug treatment in New Zealand), and overestimated by 2.4-4.1% the risk in those who scored above the 15% threshold. For both high risk and low risk ethnic groups, the New Zealand adjusted score systematically overestimated the observed 5-year event rate ranging from 0.6-5.3% at predicted risk levels below 15% to 5.4-9.3% at higher risk levels. Conclusion: The original Framingham Heart Study risk prediction score overestimates risk for the New Zealand European population but underestimates risk for the combined high risk ethnic populations. However the adjusted Framingham score used in New Zealand clinical guidelines overcompensates for this underestimate, resulting in a score that overestimates risk among the European, Maori, Pacific and Indian ethnic populations at all predicted risk levels. When sufficient person years of follow-up are available in the PREDICT cohort, new cardiovascular risk prediction scores should be developed for each of the ethnic groups to allow for more accurate risk prediction and targeting of treatment.

Human-induced climate change is now the central health issue facing humanity. The World Medical Association recently adopted the Declaration of Delhi, committing the medical profession to mitigate and adapt to the effects of climate change. This is new professional territory for many doctors. Even so, the profession has often engaged with issues outside &#39;the health sector&#39; when the stakes are high, for example leaded petrol, road safety, tobacco, and nuclear weapons. The scientific basis to the declaration merits scrutiny in light of commonly used contrary arguments. Decisions in medicine, as elsewhere, must be taken on the evidence to hand, weighing up the risks, given that complete knowledge is seldom available and time is precious. There are strong analogies between clinical experience and our approach to planetary climate. The relevant context for scientific observations on climate is the world&#39;s multi-gigatonne annual CO2-equivalent greenhouse gas emissions. Emissio...

Central line-associated bacteraemia (CLAB) is a preventable cause of patient morbidity and mortality in intensive care units. Target CLAB Zero was a national campaign that ran from October 2011 to March 2013 across all New Zealand ICUs (intensive care units). The campaign aimed to reduce the national CLAB rate to less than one incident per 1,000 line days and to establish a national measurement system for CLAB. We used Institute for Healthcare Improvement (IHI) Breakthrough Series methodology to structure the campaign. IHI bundles of care for catheter insertion and maintenance were implemented across 25 New Zealand ICUs. We collected monthly data on line days, CLAB infections and compliance with the bundles. Data were analysed using run charts. The rate of CLAB per 1,000 line days fell from 3.32 at baseline to an average of 0.28 between April 2012 and March 2013. In the final 3-month period, January to March 2013, average insertion bundle compliance was 80% and average maintenance b...

To estimate sociodemographic differences in the prevalence of coronary heart disease (CHD) in New Zealand from linked health records. We combined records of hospital treatment for CHD, dispensing of selected anti-anginal drugs and mortality to estimate the national point prevalence of coronary heart disease in New Zealand in December 2008. Stratified estimates are presented by gender; age; Māori, Pacific, Indian and &#39;Other&#39; (mainly New Zealand European) ethnic groups; and socioeconomic status. Among a &quot;health contact&quot; population of adults (greater than and equal to 15 years), about one in twenty (6.5% of men and 4.1% of women) had indicators of a past diagnosis or treatment for CHD or both. Substantial differences in prevalence occurred by gender, ethnic group and socioeconomic status. For example, among New Zealanders aged 35 to 74 years, Indian men had the highest age-adjusted prevalence (7.78%; 95%CI 7.43 to 8.15), almost double the prevalence of &#39;Other&#39;...

New Zealand must commit to substantial decreases in its greenhouse gas emissions, to avoid the worst impacts of climate change on human health, both here and internationally. We have the fourth highest per capita greenhouse gas emissions in the developed world. Based on the need to limit warming to 2 degrees C by 2100, our cumulative emissions, and our capability to mitigate, New Zealand should at least halve its greenhouse gas emissions by 2020 (i.e. a target of at least 40% less than 1990 levels). This target has a strong scientific basis, and if anything may be too lenient; reducing the risk of catastrophic climate change may require deeper cuts. Short-term economic costs of mitigation have been widely overstated in public debate. They must also be balanced by the far greater costs caused by inertia and the substantial health and social benefits that can be achieved by a low emissions society. Large emissions reductions are achievable if we mobilise New Zealand society and let te...

Background Antithrombotic medications (antiplatelets and anticoagulants) reduce the risk of cardiovascular disease (CVD), but with the disadvantage of increasing bleeding risk. Ethnicity and socioeconomic deprivation are independent predictors of major bleeds among patients without CVD, but it is unclear whether they are also predictors of major bleeds among patients with CVD or atrial fibrillation (AF) after adjustment for clinical variables. Methods Prospective cohort study of 488,107 people in New Zealand Primary Care (including 64,420 Māori, the indigenous people of New Zealand) aged 30–79 years who had their CVD risk assessed between 2007 and 2016. Participants were divided into three mutually exclusive subgroups: (1) AF with or without CVD (n = 15,212), (2) CVD and no AF (n = 43,790), (3) no CVD or AF (n = 429,105). Adjusted hazards ratios (adjHRs) were estimated from Cox proportional hazards models predicting major bleeding risk for each of the three subgroups to determine wh...

Objective To provide the background and preliminary results from the PREDICT research programme. Setting General practices affiliated with ProCare Health Ltd, a network of three Auckland-based Primary Health Organisations. Population: 370 general practitioners and 70 practice nurses who have PREDICT-CVD, a web-based cardiovascular disease risk assessment and management decision support programme, integrated with their practice software. Time: Incremental implementation from August 2002. Design: Cohort Study. Results: GPs and practice nurses have to date conducted 37,160 risk assessments on around 21,500 patients. This represents less than 10% of the ProCare population over 35yrs. Appropriate risk assessment documentation had increased four-fold with the introduction of this programme. Currently, 111 people who have been risk assessed have died and 2456 people have been hospitalised (contributing 4411 hospital admissions). Of these, 150 admissions (115 people) were admitted with a pr...

AIM Publicly-funded atorvastatin required prior approval until September 2010 whereas simvastatin did not. Our aim was to examine if overall statin dispensing and atorvastatin dispensing among patients hospitalised for cardiovascular disease (CVD) differed systematically across sociodemographic groups during and after special authority criteria. METHOD National medication dispensing data were anonymously linked to patients hospitalised across New Zealand with CVD and discharged between 1/07/2009-31/12/2009 when special authority criteria applied and 1/09/2010-28/02/2011 after restrictions ceased. Statin dispensing at least once within six months post-discharge was analysed by sociodemographic characteristics. RESULTS Overall statin use was the same (80%) among patients discharged during (n=14,094) and after (n=13,274) restrictions. With restrictions, atorvastatin dispensing was 32-33% less frequent among statin-users &lt;45 years and &gt;75 years than 65-74 year olds and 28-55% less...

AIM To investigate eGFR as an independent risk factor for CVD in a New Zealand primary care cohort, stratified by disease status (prior CVD, diabetes or no CVD or diabetes). METHOD The PREDICT-CVD open cohort study is a large, ethnically diverse, New Zealand primary care cohort, generated by using a web-based CVD risk assessment tool. Using encrypted identifiers, participant profiles were linked anonymously to a regional laboratory database (to determine renal function) and to national hospitalisation and mortality datasets. Analyses using a single baseline eGFR measurement were undertaken in three clinical sub-cohorts of participants: those with prior CVD (n=29,742), with diabetes (n=44,416) and with neither CVD nor diabetes (n=192,696). The association between baseline eGFR (by category ≥90, 60-89.9, 30-59.9, and &lt;30ml/min/1.73m2) and incident CVD was analysed with Kaplan Meier plots and Cox regression models. RESULTS After adjustment for traditional CVD risk factors, there was...

Background Both cardiovascular disease (CVD) risk and deaths from non-CVD causes, which may preclude a CVD event, increase with age. We evaluated whether accounting for the competing risk of non-CVD death improves the performance of CVD risk-prediction equations in older adults. Methods All New Zealanders aged ≥65 years in 2012 without a prior CVD hospitalization were identified by anonymized linkage of eight routinely collected national health data sets. Sex-specific equations estimating the 5-year risk of a fatal or non-fatal CVD event were constructed using standard Cox and Fine-Gray (competing-risk) approaches. The pre-specified predictors were: age, ethnicity, deprivation level, diabetes, atrial fibrillation and baseline preventive pharmacotherapy. Model performance was evaluated by assessing calibration and discrimination in the overall cohort and in ethnic and age-specific subgroups. Results Among 360 443 people aged ≥65 years with 1 615 412 person-years of follow-up, 14.6% o...

BackgroundCardiovascular disease (CVD) risk prediction equations are being used to guide risk management among increasingly older individuals. We examined the performance of recent equations, derived from a 2006 cohort including almost all New Zealanders aged 30–74 years, among older people.MethodsAll New Zealanders aged 75–89 years in contact with state-funded health services in 2006 without prior CVD or heart failure and with complete predictor data were identified by anonymised individual-level linkage of eight national administrative health datasets. Baseline 5-year CVD risk was estimated using sex-specific New Zealand risk equations, and CVD hospitalisations or deaths occurring between 2007 and 2011 inclusive were ascertained. Performance was assessed with calibration plots and standard metrics.ResultsAmong 124 358 New Zealanders aged 75–89 years old, 30 152 CVD events were recorded during follow-up. Sex-specific equations derived from 30–74 year olds slightly underestimated CV...

Introduction The Vascular Risk in Adult New Zealanders (VARIANZ) datasets contain a range of routinely-collected New Zealand health data relevant to cardiovascular disease (CVD) and related conditions. The datasets enable exploration of cardiovascular-related treatment, service utilisation, outcomes and prognosis. Processes Each dataset is constructed by anonymised individual-level linkage of eight national administrative health databases to identify all New Zealand adults aged 20 years and older who have recorded contact with publicly-funded New Zealand health services during a given year from 2006 onwards, when data quality is considered sufficient. Data contents Individual-level data for each VARIANZ dataset includes variables covering demography, dispensing of cardiovascular disease (CVD) preventive medications, prior hospitalisations for atherosclerotic CVD, heart failure, atrial fibrillation, diabetes and five-year risk of a fatal or non-fatal CVD event for those without prior...

Cardiovascular disease (CVD) risk prediction equations are primarily used in clinical settings to inform individual risk management decisions. We sought to develop and validate alternative equations derived solely from linked routinely collected national health data that could be applied countrywide to inform population health planning. Individual-level linkage of eight administrative health datasets identified all New Zealand residents aged 30-74 years in contact with publicly funded health services during 2006 with no previous hospitalizations for CVD or heart failure, and with complete data on eight pre-specified predictors. The linked health datasets encompassed demographic characteristics, hospitalizations, outpatient visits, primary care enrolment, primary care reimbursement, community laboratory requests, community pharmaceutical dispensing and mortality. Sex-specific Cox models were developed to estimate the risk of CVD death or hospitalization within 5 years and included se...

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. 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. 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. Ina...

A decision to initiate aspirin therapy for primary prevention of cardiovascular disease (CVD) requires consideration of both treatment benefits and harms. The most significant harm associated with aspirin is major bleeding, yet there is a paucity of data on bleeding risk in suitable community populations. To determine the risk of major bleeding among people without CVD who are not receiving antiplatelet therapy. Prospective cohort study of 359 166 individuals aged 30 to 79 years receiving primary care in New Zealand who had CVD risk assessment between 2002 and 2015. Participants were censored at the earliest date on which they had a first major bleeding event, died, or met any baseline cohort exclusion criteria or the study end date of December 31, 2015. Analyses were repeated after excluding people with medical conditions associated with increased bleeding risk (non-high-risk cohort; n=305 057) and after further excluding people receiving other medications associated with increased...

Most cardiovascular disease risk prediction equations in use today were derived from cohorts established last century and with participants at higher risk but less socioeconomically and ethnically diverse than patients they are now applied to. We recruited a nationally representative cohort in New Zealand to develop equations relevant to patients in contemporary primary care and compared the performance of these new equations to equations that are recommended in the USA. The PREDICT study automatically recruits participants in routine primary care when general practitioners in New Zealand use PREDICT software to assess their patients&#39; risk profiles for cardiovascular disease, which are prospectively linked to national ICD-coded hospitalisation and mortality databases. The study population included male and female patients in primary care who had no prior cardiovascular disease, renal disease, or congestive heart failure. New equations predicting total cardiovascular disease risk...

Despite widespread use of cardiovascular disease (CVD) preventive medications in cohorts used to develop CVD risk prediction models, only some incorporate baseline CVD pharmacotherapy and none account for treatment changes during study follow-up. Therefore, current risk prediction scores may underestimate the true CVD event risk. We examined changes in CVD pharmacotherapy over 5 years in preparation for developing new 5-year risk prediction models. Anonymized individual-level linkage of eight national administrative health datasets enabled identification of all New Zealanders aged 30-74 years, without prior hospitalization for CVD or heart failure, who utilized publicly funded health services during 2006. We determined proportions of participants dispensed blood pressure lowering, lipid lowering, and antiplatelet/anticoagulant pharmacotherapy at baseline in 2006, and the proportion of person years of follow-up (2007-2011) where dispensing occurred. The study population comprised of ...

To assess the effect of a point of care (POC) device for testing lipids and HbA1c in addition to testing by community laboratory facilities (usual practice) on the completion of cardiovascular disease (CVD) risk assessments in general practice. We conducted a pragmatic, cluster randomised controlled trial in 20 New Zealand general practices stratified by size and rurality and randomised to POC device plus usual practice or usual practice alone (controls). Patients aged 35-79 years were eligible if they met national guideline criteria for CVD risk assessment. Data on CVD risk assessments were aggregated using a web-based decision support programme common to each practice. Data entered into the on-line CVD risk assessment form could be saved pending blood test results. The primary outcome was the proportion of completed CVD risk assessments. Qualitative data on practice processes for CVD risk assessment and feasibility of POC testing were collected at the end of the study by interview...

Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients. Adults aged &lt;80 years with prior CVD were identified from a New Zealand primary care cohort study (PREDICT), and linked to national mortality, hospitalisation and dispensing databases. A Cox model with an outcome of myocardial infarction, stroke or CVD death within 2 years was developed. External validation was performed in a cohort from the UK. 24 927 patients, 63% men, 63% European, median age 65 years (IQR 58-72 years), experienced 1480 CVD events within 2 years after a CVD risk assessment. A risk score including ethnicity, comorbidities, body mass index, creatine creatinine and treatment, in addition to established risk factors used in primary prevention, predicted a median 2-year CVD risk of 5....

Publicly-funded atorvastatin required prior approval until September 2010 whereas simvastatin did not. Our aim was to examine if overall statin dispensing and atorvastatin dispensing among patients hospitalised for cardiovascular disease (CVD) differed systematically across sociodemographic groups during and after special authority criteria. National medication dispensing data were anonymously linked to patients hospitalised across New Zealand with CVD and discharged between 1/07/2009-31/12/2009 when special authority criteria applied and 1/09/2010-28/02/2011 after restrictions ceased. Statin dispensing at least once within six months post-discharge was analysed by sociodemographic characteristics. Overall statin use was the same (80%) among patients discharged during (n=14,094) and after (n=13,274) restrictions. With restrictions, atorvastatin dispensing was 32-33% less frequent among statin-users &lt;45 years and &gt;75 years than 65-74 year olds and 28-55% less among Māori, Pacif...

The All New Zealand Acute Coronary Syndrome Quality Improvement programme (ANZACS-QI) uses a web-based system to create a clinical registry of patients with acute coronary syndrome (ACS) and other cardiac problems admitted to hospitals across New Zealand. This detailed clinical registry is complemented by parallel analyses of, and individual linkage to, New Zealand&#39;s multiple routine health information datasets. The programme is primarily designed to support secondary care clinicians to implement evidence based guidelines and to meet national performance targets for New Zealand cardiac patients. ANZACS-QI simultaneously generates a large-scale research database and provides an electronic data infrastructure for clinical registry studies. ANZACS-QI has been successfully implemented in all the 41 public hospitals across New Zealand where acute cardiac patients are admitted. By June 2015 25,273 patients with suspected ACS and 30,696 referred for coronary angiography were registered...

To assess benefit versus harm of aspirin for cardiovascular disease (CVD) primary prevention by age group, gender and risk category and to interpret these results in light of current New Zealand CVD risk assessment and management guidelines. Rates of benefit (avoided vascular events) and harm (additional major extracranial bleeds) for each gender and age group were calculated from data from the six randomised controlled trials included in the Anti-Thrombotic Trialists&#39; (ATT) Collaboration meta-analysis. These rates were applied to CVD risk categories to calculate the net benefit or net harm likely to occur from the use of aspirin in primary prevention of CVD as monotherapy and when added to lipid and blood pressure-loweringtherapies. Benefits of aspirin monotherapy outweigh the harms for both men and women aged up to 80 years with calculated five-year CVD risk &gt;15% in primary prevention. Harm may outweigh benefit for primary prevention for those over 80 years. For men 70-79 y...

Explaining what cardiovascular disease (CVD) risk means and engaging in shared decision-making regarding risk factor modification is challenging. An electronic CVD risk visualisation tool containing multiple risk communication strategies (Your Heart Forecast) was designed in 2009. To assess whether this tool facilitated explaining CVD risk to primary care patients. Health professionals who accessed a Primary Health Organisation website or who attended educational peer groups over a three-month period were invited to complete questionnaires before and after viewing a four-minute video about the tool. Respondents were asked to make an informed guess of the CVD risk of a 35-year-old patient (actual CVD risk 5%) and rate the following sentence as being true or false: &#39;If there were 100 people like Mr Andrews, five would go on to have a cardiac event in the next five years.&#39; They also were asked to rank their understanding of CVD risk and confidence in explaining the concept to p...

Risk of cardiovascular disease (CVD) events increases with age. With treatment, individuals with highest risk accrue greater absolute risk reduction. New Zealand&#39;s CVD guidelines provide no upper age limit for risk assessment. Guidance for treating those over 75 years is limited. Little is known about GPs&#39; attitudes regarding assessing and managing cardiovascular risk among older people. A 39-item questionnaire including three cases representing various risk was developed and administered to 500 GPs randomly selected from a registry. Of the GPs, 379 were eligible; 86 (22%) responded to the questionnaire. Most were male (57%), between 40 and 59 years of age (74%), of European ethnicity (57%), had a medical degree from NZ (60%), and had been practising for at least 10 years (98%). Respondents were less likely to assess risk with increasing patient age and more likely to manage risk according to individual risk factors, rather than absolute risk. Marked variation occurred in in...

New Zealand was the first country to develop national clinical guidelines recommending that an explicit measure of absolute cardiovascular disease (CVD) risk should be the primary determinant of a decision to initiate blood pressure or lipid-lowering therapy.1 2 To facilitate the ...