title: Effect of age, gender, ethnicity, socioeconomic status and region on dispensing of CVD secondary prevention medication in New Zealand: the Atlas of Health Care Variation CVD cohort (VIEW-1).
abstract: BACKGROUND
  Triple therapy with anti-platelet/anti-coagulant, blood pressure (BP)-lowering, and statin medications improves outcomes in atherosclerotic cardiovascular disease (CVD). However, in practice there is often a substantial evidence-practice gap, with sub-optimal initiation and longer-term adherence. Our aim was to enumerate a contemporary national cohort of people with significant CVD and report the variation in CVD secondary prevention dispensing by demographic variables.
  
  
  METHODS
  Using anonymised linkage of national data sets, we identified 86,256 individuals, alive and residing in New Zealand at the end of 2010, aged 30-79 years who were hospitalised for an atherosclerotic CVD event or procedure in the previous10 years. This cohort was linked to the national pharmaceutical dispensing dataset to assess dispensing of CVD prevention medications during the 2011 calendar year. Adequate dispensing was defined as being dispensed a drug in at least 3 of the 4 quarters of the year. Multivariate regression was used to identify independent predictors of adequate dispensing.
  
  
  RESULTS
  59% were maintained on triple therapy, 77% on BP-lowering medication, 75% on anti-platelet/anti-coagulants and 70% on statins. From multivariate analysis, patients less than 50 years were about 20% less likely than older patients and women were 10% less likely than men to be maintained on triple therapy. Indian patients were about 10% more likely to be maintained on triple therapy than NZ European/Others. Those living in the Southern Cardiac Network region of New Zealand had slightly higher rates of triple therapy than National Cardiac Regions further north.
  
  
  CONCLUSIONS
  The significant under-utilisation of safe and inexpensive secondary prevention medication, particularly in younger people and women, provides an opportunity to improve CVD outcomes in this easily identifiable high-risk population.
authors.affiliation: Dept of Cardiology, Middlemore Hospital, Otahuhu, Auckland 93311, New Zealand. Andrew.Kerr@middlemore.co.nz.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
authors.forename: Dan
authors.initials: D
authors.lastname: Exeter
authors.forename: Grant
authors.initials: G
authors.lastname: Hanham
authors.forename: Corina
authors.initials: C
authors.lastname: Grey
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Zhao
authors.forename: Tania
authors.initials: T
authors.lastname: Riddell
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.forename: Sue
authors.initials: S
authors.lastname: Wells
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors