title: Regular primary care plays a significant role in secondary prevention of ischemic heart disease in a Western Australian cohort.
abstract: BACKGROUND
  Secondary prevention for established ischaemic heart disease (IHD) involves medication therapy and a healthier lifestyle, but adherence is suboptimal. Simply having scheduled regular appointments with a primary care physician could confer a benefit for IHD patients possibly through increased motivation and awareness, but this has not previously been investigated in the literature.
  
  
  OBJECTIVE
  To estimate the association between regular general practitioner (GP) visitation and rates of all-cause death, IHD death or repeat hospitalisation for IHD in older patients in Western Australia (WA).
  
  
  METHODS
  A retrospective cohort design.
  
  
  METHODS
  Patients aged  ≥  65 years (n  = 31,841) with a history of hospitalisation for IHD from 1992-2006 were ascertained through routine health data collected on the entire WA population and included in the analysis.
  
  
  METHODS
  Frequency and regularity of GP visits was determined during a three-year exposure period at commencement of follow-up. A regularity score (range 0-1) measured the regularity of intervals between the GP visits and was divided into quartiles. Patients were then followed for a maximum of 11.5 years for outcome determination. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards models.
  
  
  RESULTS
  Compared with the least regular quartile, patients with greater GP visit regularity had significantly decreased risks of all-cause death (2(nd) least, 2(nd) most and most regular: HR = 0.76, 0.71 and 0.71); and IHD death (2(nd) least, 2(nd) most and most regular: HR = 0.70, 0.68 and 0.65). Patients in the 2(nd) least regular quartile also appeared to experience decreased risk of any repeat IHD hospitalisation (HR =  0.83, 95%CI 0.71-0.96) as well as emergency hospitalisation (HR = 0.81, 95%CI 0.67-0.98), compared with the least regular quartile.
  
  
  CONCLUSIONS
  Some degree of regular GP visitation offers a small but significant protection against morbidity and mortality in older people with established IHD. The findings indicate the importance of scheduled, regular GP visits for the secondary prevention of IHD.
authors.affiliation: School of Population Health, The University of Western Australia, Perth, Australia. kristjana.einarsdottir@uwa.edu.au
authors.forename: Kristjana
authors.initials: K
authors.lastname: Einarsdóttir
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000517:prevention & control*; D011320:Primary Health Care / Q000379:methods*; D055502:Secondary Prevention / Q000379:methods*; D014904:Western Australia / Q000453:epidemiology