High Frequency of Tertiary Cardiology Referral, Admission or Death of Eligible Patients Following Delay in Recruiting for the Te Kūiti Access to Cardiology Pilot Study

Abstract

The Te Kūiti Access to Cardiology Pilot Study was designed to assess, in a high Māori proportion general practitioner (GP) population (Te Kūiti) with increased cardiovascular risk, whether a simple local screening protocol followed, if indicated, by more definitive cardiology tests performed locally would identify people for treatment or tertiary referral earlier than a normal care control group. Delay from risk score assessments to study commencement of 2.5 years occurred due to funding and COVID-19. The frequency of tertiary cardiology referral, admission, or death in this intervening period were assessed. Te Kūiti GP patients aged 35–74 with a 5-year cardiovascular disease (CVD) risk score of ≥10% (PREDICT CVD) were eligible for the study. Current cardiology or patients within 2 years were excluded. The delay to start period was between February 2020 and August 2022 (2.5 years). The proportion of eligible patients now excluded (now under or referred to Waikato Hospital cardiology, those deceased/deceased due to cardiovascular cause, and other (moved out of area, under palliative care)) was assessed. Groups were sorted by gender (male/female) and ethnicity (Māori and non-Māori). The Table show summary data of those initially eligible patients who were later excluded. The Māori and non-Māori males and Māori females were referred or died from cardiovascular disease at rates in 2.5 years close to those predicted at 5 years by PREDICT CVD. This high rate of referral/death suggests that these groups may be good targets to attempt interventions to facilitate early diagnosis and implement preventive therapies.TableMāori maleNon-Māori maleMāori femaleNon-Māori femaleTotal number with CVD risk score of ≥10% by January 202016225711954Number excluded by August 2022 “Exclusion group”46 (28.4%)60 (23.3%)25 (21.0%)10 (18.5%)Exclusion criteria: now under cardiology/referral to cardiology made23 (14.2%)37 (14.4%)16 (13.4%)3 (5.5%)Exclusion criteria: deceased10 (6.2%)7 (2.7%)4 (3.4%)1 (1.9%)Deceased due to heart disease3 (1.9%)2 (0.8%)1 (0.8%)0 (0.0)%Total cardiovascular disease exclusions26 (16.1%)39 (15.2%)17 (14.2%)3 (5.5%)Exclusion criteria: other131656Mean CVD risk score of total number17.215.517.215.1Mean CVD risk score of exclusion group17.6316.5418.5213.6 Open table in a new tab