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Health care delivery, economics and global health care
Original research
Sex disparities in the management of coronary heart disease in general practices in Australia
  1. Crystal Man Ying Lee1,2,
  2. George Mnatzaganian3,
  3. Mark Woodward4,5,
  4. Clara K Chow6,7,
  5. Freddy Sitas8,9,
  6. Suzanne Robinson10,
  7. Rachel R Huxley4,11
  1. 1 School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
  2. 2 Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Departmentof Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
  4. 4 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  5. 5 The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
  6. 6 Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
  7. 7 Westmead Hospital, Sydney, New South Wales, Australia
  8. 8 Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  9. 9 MenziesCentre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  10. 10 Health Policy and Management, Curtin University, Perth, Western Australia, Australia
  11. 11 College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Crystal Man Ying Lee, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia; c.lee2{at}latrobe.edu.au

Abstract

Objectives To determine whether sex differences exist in the management of patients with a history of coronary heart disease (CHD) in primary care.

Methods General practice records of patients aged ≥18 years with a history of CHD in a large general practice dataset in Australia, MedicineInsight, were analysed. Sex-specific, age-standardised proportions of patients prescribed with recommended medications; assessed for cardiovascular risk factors; and achieved treatment targets according to the General Practice Management Plan were reported.

Results Records of 130 926 patients (47% women) from 438 sites were available from 2014 to 2018. Women were less likely to be prescribed with recommended medications (prescribed ≥3 medications: women 44%, men 61%; p<0.001). Younger patients, especially women aged <45 years, were substantially underprescribed (aged <45 years prescribed ≥3 medications: women 2%, men 8%; p<0.001). Lower proportions of women were assessed for cardiovascular risk factors (blood test for lipids: women 70%–76%, men 77%–81%; p<0.001). Body size was not commonly assessed (body mass index: women 59%, men 62%; p<0.001; waist: women 23%, men 25%; p<0.001). Higher proportions of women than men achieved targets for most risk factors (achieved ≥4 targets in patients assessed for all risk factors: women 82%, men 76%).

Conclusion Gaps in preventative management including prescription of indicated medications and risk factor monitoring have been reported from the late 1990s and this large-scale general practice data analysis indicate they still persist. Moreover, the gap is larger in women compared to men. We need new ways to address these gaps and the sex inequity.

  • primary care
  • coronary artery disease

https://doi.org/10.1136/heartjnl-2019-315134

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    Footnotes

    • Contributors CMYL conceived the design of the study, secured funding for study, obtained the data, drafted the manuscript and is guarantor of the study. GM analysed the data and is guarantor of the study. MW provided statistical oversight. CKC provided clinical advice. FS and SR secured funding for the study. RH conceived the design of the study and secured funding for the study. All authors contributed to the interpretation of the data and critical revision of the manuscript.

    • Funding This work was supported by a National Heart Foundation of Australia Vanguard Grant (101754).

    • Competing interests RH and CMYL have received financial support from the National Heart Foundation of Australia for the submitted work; MW has received personal fees from Amgen and Kirin outside the submitted work; CKC has received grants from National Health and Medical Research Council and National Heart Foundation outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.