Regular Primary Care Plays a Significant Role in Secondary Prevention of Ischemic Heart Disease in a Western Australian Cohort
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- Einarsdóttir, K., Preen, D.B., Emery, J.D. et al. J GEN INTERN MED (2011) 26: 1092. doi:10.1007/s11606-011-1665-1
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Secondary prevention for established ischaemic heart disease (IHD) involves medication therapy and a healthier lifestyle, but adherence is suboptimal. Simply having scheduled regular appointments with a primary care physician could confer a benefit for IHD patients possibly through increased motivation and awareness, but this has not previously been investigated in the literature.
To estimate the association between regular general practitioner (GP) visitation and rates of all-cause death, IHD death or repeat hospitalisation for IHD in older patients in Western Australia (WA).
A retrospective cohort design.
Patients aged ≥ 65 years (n = 31,841) with a history of hospitalisation for IHD from 1992–2006 were ascertained through routine health data collected on the entire WA population and included in the analysis.
Frequency and regularity of GP visits was determined during a three-year exposure period at commencement of follow-up. A regularity score (range 0–1) measured the regularity of intervals between the GP visits and was divided into quartiles. Patients were then followed for a maximum of 11.5 years for outcome determination. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards models.
Compared with the least regular quartile, patients with greater GP visit regularity had significantly decreased risks of all-cause death (2nd least, 2nd most and most regular: HR = 0.76, 0.71 and 0.71); and IHD death (2nd least, 2nd most and most regular: HR = 0.70, 0.68 and 0.65). Patients in the 2nd least regular quartile also appeared to experience decreased risk of any repeat IHD hospitalisation (HR = 0.83, 95%CI 0.71–0.96) as well as emergency hospitalisation (HR = 0.81, 95%CI 0.67–0.98), compared with the least regular quartile.
Some degree of regular GP visitation offers a small but significant protection against morbidity and mortality in older people with established IHD. The findings indicate the importance of scheduled, regular GP visits for the secondary prevention of IHD.