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Issue

Vol 123 No 1309: 19 February 2010

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Issue Summary

SUMMARY

Are at-risk New Zealand women receiving recommended cardiovascular preventive therapy?

Olivia Bupha-Intr, Sally B Rose, Beverley A Lawton, C Raina Elley, Anthony C Dowell

The NZ cardiovascular guidelines recommend treatment with triple therapy (low dose aspirin, blood pressure-lowering medication and a lipid-lowering medication) for those with a 5-year CVD risk of 226515% or with established CVD. Data collected during a previous study involving 1089 40-74 year old women were used to calculate a 5-year cardiovascular (CVD) risk scores and self-reported use of cardiovascular medications. Of the 109 women at high risk (risk score 226515% or established CVD); only 17% (19/109) were taking triple therapy. These results suggest that women at high-risk are not receiving cardiovascular medications as recommended by the guidelines, but reasons for this treatment gap are unclear.

SUMMARY

Use of implantable cardioverter defibrillators in the New Zealand context from 2000 to 2007

Peter D Larsen, Praveen De Silva, Scott A Harding, Ellen Woodcock, Nigel A Lever

In patients who are at high risk of sudden cardiac death, the best treatment option is implantation of an implantable cardioverter defibrillator (ICD). This study examine the patient population at two tertiary referral hospitals receiving these devices between 2000 and 2007. The implant rate has increased across the study period, but remains about a third of the implant rate seen in Australia, suggesting that we are not implanting sufficient ICDs. The patients who are receiving the ICDs have a high therapy rate (suggesting that the devices are saving lives) and a low mortality rate by international standards.

SUMMARY

A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital

Diane N Wiseman, Jeff Harrison

A venous thromboembolism (VTE) is the formation of a blood clot in the veins and includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Venous thromboembolism (VTE) is an important cause of ill health and death in hospitalised patients. The prevention of VTE using mechanical and/or pharmacological methods has been shown to be effective, safe and cost-effective. However, many hospitalised patients at-risk of VTE do not receive prophylaxis, and guideline recommendations continue to be overlooked.

SUMMARY

A comparative analysis of the cardiovascular disease risk factor profiles of Pacific peoples and Europeans living in New Zealand assessed in routine primary care: PREDICT CVD-11

Corina Grey, Sue Wells, Tania Riddell, Andrew Kerr, Dudley Gentles, Romana Pylypchuk, Roger Marshall, Shanthi Ameratunga, Paul Drury, C Raina Elley, Cambell Kyle, Rod Jackson

This paper reports on differences in cardiovascular disease risk profiles between Europeans and Pacific peoples assessed in routine primary care practice using a web-based clinical decision support programme known as PREDICT. Pacific men were one and a half times more likely to be current smokers than European men. Diabetes rates were three times higher for Pacific peoples compared to Europeans. Overall cardiovascular risk scores (which predict the risk of experiencing a cardiovascular event, such as a heart attack or stroke, in the next 5 years) were significantly higher in Pacific men and women compared to European men and women. These differences in cardiovascular risk factors help explain the higher rates of cardiovascular deaths among Pacific peoples compared to Europeans in New Zealand and should be used to plan appropriate interventions.

SUMMARY

Performance of Framingham cardiovascular risk scores by ethnic groups in New Zealand: PREDICT CVD-10

Tania Riddell, Sue Wells, Rod Jackson, Ai-Wei Lee, Sue Crengle, Dale Bramley, Shanthi Ameratunga, Romana Pylypchuk, Joanna Broad, Roger Marshall, Andrew Kerr

Estimating a patients cardiovascular risk is important to help target whether they require treatment or not. The Framingham risk score is based on a medical research done over 30 years ago on about 5000 mainly white, middle-class North Americans from Framingham, Massachusetts. This original score was modified by the New Zealand Guidelines Group to compensate for those ethnic groups collectively considered to be at higher risk (M ori, Pacific and Indian). The adjustment was successful in making up for the underestimation of risk for people in these ethnic groups. However, it was crude and the adjustment made was too large across all the groups. We require further time and research to refine cardiovascular risk prediction scores that are more accurate for M ori, Pacific and Indian peoples.

SUMMARY

Door to balloon times: streamlining admission for primary percutaneous coronary intervention

Neil Swanson, Christopher Nunn, Steve Holmes, Gerry Devlin

When patients are having a heart attack, one of the main coronary blood vessels has become blocked with blood clot. Currently, the best treatment for this is to unblock the blood vessel using a tiny balloon inside the vessel, which is called coronary angioplasty. It is extremely important to do this treatment as quickly as possible, to limit the damage done by the heart attack and improve the chances of the patient surviving. We have looked at how heart attack patients are admitted to our hospital and made changes to speed up this process, resulting in a much reduced time before angioplasty is performed.

ALL ARTICLES
SUMMARY

Special series: Maximising learning through effective supervision

Joy Rudland, Warwick Bagg, Stephen Child, Wayne de Beer, Wayne Hazell, Phillippa Poole, Dale Sheehan, Tim J Wilkinson

Deaths from Exophthalmic Goitre (Graves' Disease)

Are at-risk New Zealand women receiving recommended cardiovascular preventive therapy?

Olivia Bupha-Intr, Sally B Rose, Beverley A Lawton, C Raina Elley, Anthony C Dowell

Use of implantable cardioverter defibrillators in the New Zealand context from 2000 to 2007

Peter D Larsen, Praveen De Silva, Scott A Harding, Ellen Woodcock, Nigel A Lever

Systems of care: need for hub and spoke systems of care for patients with myocardial infarction. A call for action

Harvey D White

A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital

Diane N Wiseman, Jeff Harrison

Severe hepatitis in a primary sclerosing cholangitis patient receiving recent cetirizine therapy

Ricardo Jurawan, Anthony Smith

Cultural issues in research, a reflection

Rawiri Blundell, Veronique Gibbons, Steven Lillis

National Women’s Hospital deserves a fair and balanced history—with response by Linda Bryder

Ron W Jones

Timothy Savage

A comparative analysis of the cardiovascular disease risk factor profiles of Pacific peoples and Europeans living in New Zealand assessed in routine primary care: PREDICT CVD-11

Corina Grey, Sue Wells, Tania Riddell, Andrew Kerr, Dudley Gentles, Romana Pylypchuk, Roger Marshall, Shanthi Ameratunga, Paul Drury, C Raina Elley, Cambell Kyle, Rod Jackson

The changing face of prehospital care in New Zealand: the role of extended care paramedics

Andrew H Swain, Sarah R Hoyle, Andrew W Long

Sudden infant death and co-sleeping: a better message

David Tipene-Leach

Performance of Framingham cardiovascular risk scores by ethnic groups in New Zealand: PREDICT CVD-10

Tania Riddell, Sue Wells, Rod Jackson, Ai-Wei Lee, Sue Crengle, Dale Bramley, Shanthi Ameratunga, Romana Pylypchuk, Joanna Broad, Roger Marshall, Andrew Kerr

Medical image. Haematometrocolpos secondary to vaginal atresia: US and MRI findings

Selim Doganay, Ali Yikilmaz, Guven Kahriman, Ibrahim Sacit Tuna, Abd 00fclhakim Coskun

Cerebral venous thrombosis in autoimmune enteropathy

Annemarei Ranta, Rohitha Mokanahalli

New Zealand primary implantable cardioverter defibrillator implantation and biventricular pacing guidelines

Warren Smith on behalf of the New Zealand Pacing and Electrophysiology Group

Door to balloon times: streamlining admission for primary percutaneous coronary intervention

Neil Swanson, Christopher Nunn, Steve Holmes, Gerry Devlin

Prevalence of smoking in rural Samoa

Shawn S Barnes, Christian Small, Jillian Bennett, Jason Barnes, Ryan Keogh

Book Review: Safer Surgery: Analysing Behaviour in the Operating Theatre (Rhona Flin and Lucy Mitchell, eds)

Peter Stiven

Medical image. Horn that does not adorn

Sanjay K Bandyopadhyay, Ranjana Bandyopadhyay, Anita Dutta

Robert Lawson Thompson

Evaluation and management of fever in children

Tony Walls

Susan Dorothy Frances Clements (née Alexander)

SUMMARY

Are at-risk New Zealand women receiving recommended cardiovascular preventive therapy?

Olivia Bupha-Intr, Sally B Rose, Beverley A Lawton, C Raina Elley, Anthony C Dowell

The NZ cardiovascular guidelines recommend treatment with triple therapy (low dose aspirin, blood pressure-lowering medication and a lipid-lowering medication) for those with a 5-year CVD risk of 226515% or with established CVD. Data collected during a previous study involving 1089 40-74 year old women were used to calculate a 5-year cardiovascular (CVD) risk scores and self-reported use of cardiovascular medications. Of the 109 women at high risk (risk score 226515% or established CVD); only 17% (19/109) were taking triple therapy. These results suggest that women at high-risk are not receiving cardiovascular medications as recommended by the guidelines, but reasons for this treatment gap are unclear.

SUMMARY

Use of implantable cardioverter defibrillators in the New Zealand context from 2000 to 2007

Peter D Larsen, Praveen De Silva, Scott A Harding, Ellen Woodcock, Nigel A Lever

In patients who are at high risk of sudden cardiac death, the best treatment option is implantation of an implantable cardioverter defibrillator (ICD). This study examine the patient population at two tertiary referral hospitals receiving these devices between 2000 and 2007. The implant rate has increased across the study period, but remains about a third of the implant rate seen in Australia, suggesting that we are not implanting sufficient ICDs. The patients who are receiving the ICDs have a high therapy rate (suggesting that the devices are saving lives) and a low mortality rate by international standards.

SUMMARY

A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital

Diane N Wiseman, Jeff Harrison

A venous thromboembolism (VTE) is the formation of a blood clot in the veins and includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Venous thromboembolism (VTE) is an important cause of ill health and death in hospitalised patients. The prevention of VTE using mechanical and/or pharmacological methods has been shown to be effective, safe and cost-effective. However, many hospitalised patients at-risk of VTE do not receive prophylaxis, and guideline recommendations continue to be overlooked.

SUMMARY

A comparative analysis of the cardiovascular disease risk factor profiles of Pacific peoples and Europeans living in New Zealand assessed in routine primary care: PREDICT CVD-11

Corina Grey, Sue Wells, Tania Riddell, Andrew Kerr, Dudley Gentles, Romana Pylypchuk, Roger Marshall, Shanthi Ameratunga, Paul Drury, C Raina Elley, Cambell Kyle, Rod Jackson

This paper reports on differences in cardiovascular disease risk profiles between Europeans and Pacific peoples assessed in routine primary care practice using a web-based clinical decision support programme known as PREDICT. Pacific men were one and a half times more likely to be current smokers than European men. Diabetes rates were three times higher for Pacific peoples compared to Europeans. Overall cardiovascular risk scores (which predict the risk of experiencing a cardiovascular event, such as a heart attack or stroke, in the next 5 years) were significantly higher in Pacific men and women compared to European men and women. These differences in cardiovascular risk factors help explain the higher rates of cardiovascular deaths among Pacific peoples compared to Europeans in New Zealand and should be used to plan appropriate interventions.

SUMMARY

Performance of Framingham cardiovascular risk scores by ethnic groups in New Zealand: PREDICT CVD-10

Tania Riddell, Sue Wells, Rod Jackson, Ai-Wei Lee, Sue Crengle, Dale Bramley, Shanthi Ameratunga, Romana Pylypchuk, Joanna Broad, Roger Marshall, Andrew Kerr

Estimating a patients cardiovascular risk is important to help target whether they require treatment or not. The Framingham risk score is based on a medical research done over 30 years ago on about 5000 mainly white, middle-class North Americans from Framingham, Massachusetts. This original score was modified by the New Zealand Guidelines Group to compensate for those ethnic groups collectively considered to be at higher risk (M ori, Pacific and Indian). The adjustment was successful in making up for the underestimation of risk for people in these ethnic groups. However, it was crude and the adjustment made was too large across all the groups. We require further time and research to refine cardiovascular risk prediction scores that are more accurate for M ori, Pacific and Indian peoples.

SUMMARY

Door to balloon times: streamlining admission for primary percutaneous coronary intervention

Neil Swanson, Christopher Nunn, Steve Holmes, Gerry Devlin

When patients are having a heart attack, one of the main coronary blood vessels has become blocked with blood clot. Currently, the best treatment for this is to unblock the blood vessel using a tiny balloon inside the vessel, which is called coronary angioplasty. It is extremely important to do this treatment as quickly as possible, to limit the damage done by the heart attack and improve the chances of the patient surviving. We have looked at how heart attack patients are admitted to our hospital and made changes to speed up this process, resulting in a much reduced time before angioplasty is performed.

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