Patients with multiple conditions get heart drugs they may not need
A New Zealand study of 430,000 patients reveals that people with multiple chronic conditions are 3 times more likely to receive preventive heart medications—even when their cardiovascular risk doesn't warrant it. The finding suggests primary care systems may be over-treating complex patients, raising questions about medication safety, costs, and the effectiveness of risk-based treatment guidelines.
Originaltitel: Multimorbidity and cardiovascular prevention in primary care: Cohort study in New Zealand
BACKGROUND: Multimorbidity adds complexity to medication management. National guidelines in New Zealand (NZ) recommend dual therapy with blood-pressure- and lipid-lowering agents for most patients at five-year cardiovascular disease (CVD) risk ≥15% (high risk), considered at 5-14% (intermediate risk), and not generally recommended at <5% (low risk). AIM: To examine the association between multimorbidity and dispensing of dual therapy across risk strata. DESIGN AND SETTING: A cohort study among 430,286 patients aged 30-79 years without prior CVD, enrolled in the NZ Primary Health Organisation ProCare in 2014. METHOD: Multivariable Poisson regression estimated relative risks (RR) for dual therapy across CVD risk groups at cohort entry. Two-year maintenance of dual therapy was then compared by multimorbidity within each risk stratum. RESULTS: Baseline dual therapy receipt was 1.5%, 31% and 40% in low, intermediate and high risk groups respectively. Multimorbidity was associated with greater use of dual therapy across risk groups (low risk: RR 2.90 [95% CI 2.77-3.03]; intermediate risk: RR 1.35 [95% CI 1.32-1.38]; high risk: RR 1.15 [95% CI 1.10-1.22]). Multimorbidity was also associated with higher maintenance in the low (88% vs 84%) and intermediate (90% vs 86%) risk groups (both p<0.001) and was high, irrespective of multimorbidity, in high risk (89% vs 88%; p=0.415). CONCLUSION: Patients with multimorbidity were more likely than others to be commenced on and maintain CVD prevention. However, while dispensing increased with increasing CVD risk, a large evidence-practice gap in dual therapy remained for those at high CVD risk.