Assessing Māori/non-Māori differences in cardiovascular disease risk and risk management in routine primary care practice using web-based clinical decision support: (PREDICT CVD-2)

Abstract

Aim: To describe the cardiovascular disease risk factor status and risk management of Māori compared with non-Māori patients opportunistically assessed in routine practice using PREDICT-CVD, an electronic clinical decision support programme.

Methods: In August 2002, a primary healthcare organisation, ProCare, implemented PREDICT-CVD as an opportunistic cardiovascular risk assessment and management programme. Between 2002 and February 2006, over 20,000 cardiovascular risk assessments were undertaken on Māori and non-Māori patients. Odds ratios and mean differences in cardiovascular risk factors and risk management for Māori compared to non-Māori (European and other, Pacific, Indian, and other Asian) patients were calculated.

Results: Baseline risk assessments were completed for 1450 (7%) Māori patients and 19, 164 (93%) non-Māori patients. On average, Māori were risk assessed 3 years younger than non-Māori. Māori patients were three times more likely to be smokers, had higher blood pressure and TC/HDL levels, and twice the prevalence of diabetes and history of cardiovascular disease as non-Māori. Among patients with a personal history of cardiovascular disease, Māori were more likely than non-Māori to receive anticoagulants, blood pressure-lowering and lipid-lowering medications. However, of those patients with a history of ischaemic heart disease, Māori were only half as likely as non-Māori to have had a revascularisation procedure.

Conclusion: An electronic decision support programme can be used to systematically generate cardiovascular disease risk burden and risk management data for Māori and non-Māori populations in routine clinical practice in real-time. Moreover, the PREDICT-CVD programme has established one of the largest cohorts of Māori and non-Māori ever assembled in New Zealand. Initial findings suggest that Māori are more likely than non-Māori to receive drug-based cardiovascular risk management if they have a personal history of cardiovascular disease. In contrast, among the subgroup of patients with a history of ischaemic heart disease, Māori appear to receive significantly fewer revascularisations than non-Māori.