Regular primary care plays a significant role in secondary prevention of ischemic heart disease in a Western Australian cohort

Abstract

Background: 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.

Objective: 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).

Design: A retrospective cohort design.

Participants: 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.

Main measures: 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.

Key results: Compared with the least regular quartile, patients with greater GP visit regularity had significantly decreased risks of all-cause death (2(nd) least, 2(nd) most and most regular: HR = 0.76, 0.71 and 0.71); and IHD death (2(nd) least, 2(nd) most and most regular: HR = 0.70, 0.68 and 0.65). Patients in the 2(nd) 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.

Conclusions: 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.