Use of aspirin and statins for cardiovascular risk reduction in New Zealand: The residential care story

Abstract

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality for older New Zealanders. Medication prescribing for secondary prevention of cardiovascular events in residential care is unknown and prescribing patterns for aspirin and statins by general practitioners (GPs) in residential care facilities in Auckland, New Zealand are reported here. A representative sample of residential care facilities, all residents over age 65 years and their GPs in one district health board region in Auckland were recruited. Prescribing and medical records were audited by a trained nurse and medications coded into classes according to a standardised process. Diagnoses from summary sheets and hospital letters were recorded. Descriptive statistics were used to show variability in proportion of residents prescribed aspirin and statins. Of a total of 24 facilities approached, 14 consented to participate (58%); 537 residents (88% of eligible) agreed to participate and 533 completed the study. Residents took on average 8.3 (standard deviation 2.4) medications. On average 2.64 (range 1-6) GPs serviced each facility with eight GPs working in more than one facility. On average 54% of residents with documented CVD were prescribed aspirin and 31% of those with CVD and/or dyslipidaemia were prescribed statins. Variability between prescribers and facilities was high. Prescribing in residential care does not appear to be guidelines-based. The reasons for this are unknown. Ongoing social debate about the role of prevention for older people and interventions for GPs and residential care facilities may impact prescribing rates.