title: Initiation and maintenance of cardiovascular medications following cardiovascular risk assessment in a large primary care cohort: PREDICT CVD-16.
abstract: OBJECTIVE
  To examine whether use of a standardized cardiovascular disease (CVD) risk assessment recommended by national guidelines is associated with appropriate initiation and maintenance of medication in a large primary care cohort.
  
  
  METHODS
  A total of 90,631 people aged 30-80 years were followed for up to 3 years after a formal CVD risk assessment was undertaken between January 2006 and October 2009, during routine primary care visits in New Zealand. Patients either had prior CVD or had their CVD risk estimated using a modified Framingham prediction equation for fatal or non-fatal CVD events. The individual risk profiles were anonymously linked to national dispensing data for blood-pressure-lowering and lipid-lowering medications in the 6-month period before and in consecutive 6-month blocks after the baseline CVD risk assessment.
  
  
  RESULTS
  At baseline, a combination of blood-pressure-lowering and lipid-lowering therapy was already being used by about two-thirds of patients with prior CVD, one-quarter with a 5-year CVD risk greater than 10% (approximately 20% 10-year risk), and one-tenth with CVD risk below this level. Among these previously treated patients, dispensing rates for blood-pressure-lowering, lipid-lowering, or both medications together declined by only 4⊟16% up to 3 years after baseline assessment, irrespective of risk category. Among patients untreated at baseline, combination therapy was initiated within 6 months for 21% with prior CVD, 16% with 5-year CVD risk greater than 15% (approximately 30% 10-year risk and the national drug-treatment threshold), 10% with 5-year CVD risk between 10 and 14% (approximately 20⊟29% 10-year risk), and 3% in the lowest risk category. Across the study population, patients with prior CVD had the highest dispensing rates for each category of medication, and incrementally higher dispensing rates were noted as CVD risk group increased.
  
  
  CONCLUSIONS
  In this primary care cohort, most patients already using CVD medications at the time of the baseline CVD risk assessment maintained treatment over a maximum of 3 years follow up, irrespective of their estimated baseline risk. Among patients untreated at baseline, subsequent dispensing rates were strongly related to estimated CVD risk group. Around 15⊟20% of untreated patients meeting national drug-treatment criteria commenced combination pharmacotherapy within 6 months of CVD risk assessment.
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Suneela
authors.initials: S
authors.lastname: Mehta
authors.forename: Sue
authors.initials: S
authors.lastname: Wells
authors.forename: Corina
authors.initials: C
authors.lastname: Grey
authors.forename: Tania
authors.initials: T
authors.lastname: Riddell
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
authors.forename: Roger
authors.initials: R
authors.lastname: Marshall
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
authors.forename: Jeff
authors.initials: J
authors.lastname: Harrison
authors.forename: Tim
authors.initials: T
authors.lastname: Kenealy
authors.forename: Dale
authors.initials: D
authors.lastname: Bramley
authors.forename: Wing Cheuk
authors.initials: WC
authors.lastname: Chan
authors.forename: Simon
authors.initials: S
authors.lastname: Thornley
authors.forename: Gerhard
authors.initials: G
authors.lastname: Sundborn
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D020000:Decision Support Systems, Clinical / Q000639:trends*; D003661:Decision Support Techniques; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D000960:Hypolipidemic Agents