Sex Disparities in the Management of Coronary Heart Disease in Primary Care in Australia

Abstract

Introduction: Primary care has been shown to be an important component for the secondary prevention of cardiovascular disease. Small-scale studies in Australia have reported coronary heart disease (CHD) management gaps in primary care from the late 1990s. Using the largest and most contemporary Australian general practice dataset (MedicineInsight), the aim of this study was to determine whether sex differences exist in the management of CHD patients. Methods: General practice records of patients aged ≥18 years with a history of CHD and at least three visits in two years were analysed. Sex-specific, age-standardised proportions of patients (1) currently prescribed with medications; (2) assessed for cardiovascular risk factors; and (3) achieved treatment targets; that were recommended in the General Practice Management Plan for CHD and could be evaluated with MedicineInsight were reported. Results: Altogether, records of 130,926 patients (46.7% women) from 438 sites across Australia were available from 2014–2018. Compared to men, women were less likely to be prescribed with recommended medications (prescribed ≥3 medications: women 44%, men 61%; p < 0.001) and to be assessed for risk factors. In contrast, women were more likely to have achieved treatment targets (achieved ≥4 targets in those assess for all risk factors: women 82%, men 76%; p < 0.001). Conclusion: Despite assessment, prescribing and treatment gaps have been reported previously, this large-scale analysis of general practice data indicate they still persist. Moreover, the gaps are larger in women compared to men. New approaches are needed to address the CHD management gaps and related gender inequality.