A cross-sectional study of secondary cardiac care in general practice: impact of personal and practice characteristics

Objective. To determine the impact of patient (age, gender, type of and time since diagnosis) and practice (rurality, number of partners, availability of practice nurse) characteristics on secondary cardiac care in general practice in a country without universal registration. Methods. Medical and demographic data were gathered from the medical charts of 1611 eligible patients from 35 randomly selected practices. Eligible patients were aged under 80 years with a recorded history of acute myocardial infarction, percutaneous trans coronary arteriogram or angina. Self-report data about diet, exercise, smoking and alcohol consumption were provided from postal questionnaire (1084 patients responded; 69% response rate). Results. Having an angina only diagnosis significantly decreased the likelihood of patients being prescribed aspirin (OR = 0.53; 95% CI = 0.40-0.69), lipid-lowering medication (OR = 0.55; 95% CI = 0.43-0.69) or ACE inhibitors (OR = 0.62; 95% CI = 0.48-0.81). Younger patients (OR = 1.05; 95% CI = 1.04-1.06) were also more likely to be prescribed lipid-lowering medication. Cholesterol was predicted by gender only, with females having significantly higher cholesterol (B = -0.41; 95% CI = -0.54 to -0.27). The number of missed opportunities for secondary cardiac care was greater among patients with angina only (B = 0.39; 95% CI = 0.19-0.60). The amount of variance explained by practice and patient variables overall for each of the measures was small, ranging from 2 to 6%. Conclusions. Practice size or location appears to have little impact on secondary cardiac care. The most consistent significant personal characteristic finding was that patients with a diagnosis of angina only were significantly less likely to receive aspirin, statins or ACE inhibitors and more likely to have more missed opportunities for secondary cardiac care.