Posted 2nd Nov 2012 in Health Quality Evaluation

The Health Quality & Safety Commission, in conjunction with the School of Population Health at the University of Auckland, has developed a cardiovascular disease (CVD) domain for its Atlas of Healthcare Variation. The CVD Atlas domain examines the differences in the use of medication in patients with cardiovascular disease.

The Atlas is a tool from the Commission which enables clinicians, providers and users of health services to see variation in the health care patients receive, by geographical area. It is designed to prompt debate and raise questions among clinicians, users and providers of health services about health service use and provision.

The CVD Atlas domain focusses on the treatment of New Zealand residents with a history of cardiovascular disease, defined as those who were hospitalised with an ischaemic CVD event such as heart attack, stroke and/or coronary or peripheral arterial procedure.

Current New Zealand guidelines suggest that, unless otherwise indicated, people who have experienced a CVD event should be treated with a statin, a blood pressure lowering drug and an antiplatelet or anticoagulant drug, a combination of medications known as triple therapy.

The use of medications by people who were hospitalised with a CVD event between 2000 and 2010 were examined. There is strong evidence that the use of all three medications can reduce the risk of a subsequent CVD event by up to 50 percent over a five-year period.

Dr Andrew Kerr Head of Cardiology, Middlemore Hospital says that several interesting areas of variation in the care of CVD were identified in the study.

“Fewer CVD patients received statins compared to blood pressure lowering and antiplatelet/anticoagulants drugs, and fewer women were given these medications compared to men,”

“Younger patients were far less likely than older patients to be given secondary medication, and interestingly there were no obvious socioeconomic differences in dispensing of CVD treatment,” he says.

Once age, gender, deprivation and region were adjusted for, people from Indian populations were approximately 10 percent more likely to be dispensed triple therapy. No other significant differences between ethnic groups were identified.

The findings of the Atlas are intended to encourage questions about why variation in health care exists, rather than make judgements about the results.

“We want to generate discussion about the results and we hope that these discussions will be used to drive improvement in health care services throughout New Zealand,” says Dr Kerr.

Sidebar