Cardiovascular disease risk management for Maori in New Zealand general practice

Abstract

INTRODUCTION: Maori are overrepresented in cardiovascular disease (CVD) mortality and morbidity statistics in New Zealand (NZ). AIM: To examine cardiovascular risk (CVR) assessment and management for Maori, utilising Caring Does Matter (CDM) initiative data. METHODS: Using 16 general practices? electronic medical records ? which include ethnicity data ? the rate of CVR screening, CVD medication treatment and adherence levels, and physiological measures for Maori patients at high CVR (=15% five-year risk of a cardiovascular event) were compared to findings for Pacific and non-Maori/non-Pacific patients. RESULTS: Records for 72 351 adults (10 358 Maori; 14%) showed that Maori patients have a poorer CVR assessment rate (46% at guideline-indicated age) than Pacific and non-Maori/non-Pacific groups; when assessed, a greater proportion of Maori patients (38%) were at high CVR. The proportion of high-CVR Maori patients being treated with oral antidiabetic medication (42%) was lower than for Pacific patients but higher than for non-Maori/non-Pacific patients. Lower rates of antihypertensive adherence were found for high-CVR Maori patients than for non-Maori/non-Pacific patients (although higher than for Pacific patients). The high-CVR Maori patients who adhered to CVD medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers. DISCUSSION: The association between higher medication adherence and better control of risk factors suggests that adherence should be further promoted by clinicians. More active CVR assessment, treatment and support of medication adherence in Maori attending general practices is justified, given their high mortality rate from CVD in comparison to the overall NZ population. KEYWORDS: Antihypertensives; blood pressure; cardiovascular diseases; haemoglobin A, glycosylated; medication adherence