Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: findings from the Kanyini Audit.

OBJECTIVE: To describe cardiovascular disease (CVD) risk management in Indigenous primary health care. DESIGN, SETTING AND PARTICIPANTS: Review of 1165 randomly selected case records of Indigenous Australian adults, aged >/= 18 years, regularly attending eight health services in diverse settings in New South Wales, Queensland and Central Australia, October 2007 - May 2008. MAIN OUTCOME MEASURE: Adherence to CVD risk screening and management guidelines, especially with respect to overall or absolute CVD risk.
RESULTS: More than half the people in the sample (53%) were not adequately screened for CVD risk according to national recommendations. Underscreening was significantly associated with younger age, less frequent attendance, and lower uptake of the Medicare Health Assessment. Of the sample, 9% had established CVD, and 29% of those aged >/= 30 years were classified as high risk according to the 2004 National Heart Foundation of Australia (NHFA) adjusted Framingham equation. Of those with CVD, 40% (95% CI, 30%-50%) were not prescribed a combination of blood pressure (BP) medicines, statins and antiplatelet agents, and 56% (95% CI, 49%-62%) of high-risk individuals without CVD were not prescribed BP medicines and statins. For high-risk individuals not prescribed BP medicines or statins, 74% (95% CI, 64%-84%) and 30% (95% CI, 23%-39%) respectively, did not meet 2004 NHFA criteria for prescribing of these medications, and of those already prescribed BP medicines or statins, 41% (95% CI, 36%-47%) and 59% (95% CI, 52%-66%) did not meet respective guideline targets.
CONCLUSIONS: These management gaps are similar to those found in non-Indigenous health care settings, suggesting deficiencies across the health system. Prescribing guidelines which exclude many high-risk individuals contribute to suboptimal management. Guideline reform and improved health service capacity could substantially improve Indigenous vascular health.