Impact of medical consultation frequency on risk factors and medications 6 months after acute coronary syndrome

Karice Hyun; David Brieger; Clara Chow; Marcus Ilton; David Amos; Kevin Alford; Philip Roberts-Thomson; Karla Santo; Emily Atkins; Julie Redfern

doi:10.1071/phrp2611606

RESEARCH ARTICLE (Open Access)

Impact of medical consultation frequency on risk factors and medications 6 months after acute coronary syndrome

Karice Hyun ^A , David Brieger ^C , Clara Chow ^A ^B , Marcus Ilton ^D , David Amos ^E , Kevin Alford ^F , Philip Roberts-Thomson ^G , Karla Santo ^A , Emily Atkins ^A and Julie Redfern ^A ^*

+ Author Affiliations

- Author Affiliations

^A The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia

^B Cardiology Department, Westmead Hospital, Sydney, NSW, Australia

^C Cardiology Department, Concord Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia

^D Cardiology Department, Royal Darwin Hospital, NT, Australia

^E Cardiology Department, Orange Health Service, NSW, Australia

^F Cardiology Department, Port Macquarie Base Hospital, NSW, Australia

^G Cardiology Department, Royal Hobart Hospital, Tasmania, Australia

^* Correspondence to: jredfern@georgeinstitute.org.au

Public Health Research and Practice 26, e2611606 https://doi.org/10.17061/phrp2611606

Published: 28 January 2016

2016 © Hyun et al. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.

Abstract

Objective:Initiatives that support primary care to better enable delivery of optimal prevention services are of great importance. The purpose of this study was to examine the frequency of medical consultations by patients with acute coronary syndrome (ACS) in the 6 months after hospital discharge and to determine whether the frequency of visits was associated with differences in lifestyle, clinical measures and medication prescription. Methods:We conducted a retrospective subgroup analysis of data collected in the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE), which is an ongoing (prospective) clinical initiative providing continuous real-time reporting on the clinical characteristics, management and outcomes of patients admitted to Australian hospitals with ACS. We compared clinical measures, medications, smoking status and receipt of cardiac rehabilitation with frequency of medical consultations 6 months after hospital discharge. Results:Patients with ACS visited their general practitioner (GP) a mean of 4.4 (± 3.8) times and their cardiologist 1.2 (± 0.9) times in the 6-month period after their index admission. Patients who saw a GP in the 6-month period had significantly higher rates of participation in cardiac rehabilitation, receipt of dietary advice and prescription of cardioprotective medications. Factors associated with increased frequency of GP visits were older age groups (oldest fourth vs youngest fourth incidence rate ratio (IRR) 1.08; 95% CI 1.01, 1.14), being female (male vs female IRR 0.83; 95% CI 0.80, 0.86), diagnosis of ST-segment elevation myocardial infarction (STEMI) (STEMI vs non-STEMI IRR 1.08; 95% CI 1.04, 1.13; STEMI vs unstable angina IRR 1.01; 95% CI 0.95, 1.06), being a current smoker (IRR 1.09; 95% CI 1.05, 1.15), history of cardiovascular disease (IRR 1.06; 95% CI 1.01, 1.12), history of diabetes (IRR 1.25; 95% CI 1.21, 1.31), inpatient revascularisation (IRR 0.95; 95% CI 0.91, 0.99), receipt of cardiac rehabilitation referral (IRR 0.93; 95% CI 0.89, 0.97), and discharged on four or more out of five indicated medications (IRR 1.04; 95% CI 1.00, 1.08). Conclusion:The majority of ACS survivors in this study saw their GP frequently and their cardiologist at least once during the 6 months after index admission. Seizing these opportunities to engage, manage and support patients is important for strengthening prevention in primary care.