Equity of access to CVD risk management using electronic clinical decision support in the coronary care unit

Area of Science:

• Cardiology
• Health Informatics
• Public Health

Background:

• Cardiovascular disease (CVD) risk management after myocardial infarction (MI) is often inconsistently applied, disproportionately affecting high-need populations.
• The Acute PREDICT Initiative is a nurse-led computerised decision support system (CDSS) designed to deliver guideline-based, patient-specific CVD risk management recommendations at the point of care.

Purpose of the Study:

• To evaluate the effectiveness and equity of the Acute PREDICT Initiative in delivering cardiovascular risk management post-MI.
• To assess whether the CDSS addresses the 'inverse care law' by ensuring equitable access for all patient groups.

Main Methods:

• A retrospective analysis of patients admitted to Middlemore Hospital CCU over two years with acute CVD-related events.
• Data collected included age, gender, ethnicity, and socioeconomic status (NZDep01).
• Eligibility for PREDICT assessment and completion rates were analyzed across different demographic and socioeconomic strata.

Main Results:

• 81% of admitted patients were eligible for PREDICT assessment, with 54% receiving a complete assessment.
• Equitable access was observed across deprivation quintiles and ethnicities.
• However, assessments were less frequent for the elderly (>75 years), women, and patients with multiple previous admissions.

Conclusions:

• The PREDICT system facilitated equitable in-hospital cardiovascular risk management for patients based on ethnic and socioeconomic background post-MI.
• Certain high-risk groups, including the elderly and women, underutilized the system, indicating areas for targeted improvement.