TITLE

The association between processes, structures and outcomes of secondary prevention care among VA ischemic heart disease patients

AUTHOR(S)
Ho, P Michael; Prochazka, Allan V; Magid, David J; Sales, Anne E; Grunwald, Gary K; Hammermeister, Karl E; Rumsfeld, John S
PUB. DATE
January 2006
SOURCE
BMC Cardiovascular Disorders;2006, Vol. 6, p6
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Hyperlipidemia and hypertension are well-established risk factors for recurrent cardiovascular events among patients with ischemic heart disease (IHD). Despite national recommendations, concordance with guidelines for LDL cholesterol and blood pressure remains inadequate. The objectives of this study were to 1) determine concordance rates with LDL cholesterol and BP recommendations; and 2) identify patient factors, processes and structures of care associated with guideline concordance among VA IHD patients. Methods: This was a cross sectional study of veterans with IHD from 8 VA hospitals. Outcomes were concordance with LDL guideline recommendations (LDL<100 mg/dl), and BP recommendations (<140/90 mm Hg). Cumulative logit and hierarchical logistic regression analyses were performed to identify patient factors, processes, and structures of care independently associated with guideline concordance. Results: Of 14,114 veterans with IHD, 55.7% had hypertension, 71.5% had hyperlipidemia, and 41.6% had both conditions. Guideline concordance for LDL and BP were 38.9% and 53.4%, respectively. However, only 21.9% of the patients achieved both LDL <100 mg/dl and BP <140/90 mm Hg. In multivariable analyses, patient factors including older age and the presence of vascular disease were associated with worse guideline concordance. In contrast, diabetes was associated with better guideline concordance. Several process of care variables, including higher number of outpatient visits, higher number of prescribed medications, and a recent cardiac hospitalization were associated with better guideline concordance. Among structures of care, having on-site cardiology was associated with a trend towards better guideline concordance. Conclusion: Guideline concordance with secondary prevention measures among IHD patients remains suboptimal. It is hoped that the findings of this study can serve as an impetus for quality improvement efforts to improve upon secondary prevention measures and reduce the morbidity and mortality of patients with known IHD.
ACCESSION #
29404239

 

Related Articles

  • Non-HDL vs. LDL: Which Carries the Greater Risk? Orringer, Carl E. // Cardiology Today;Feb2012 Practical Lipidology, p11 

    The article examines the clinical utility of non-low-density lipoprotein cholesterol (HDL-C) in assessing coronary heart disease (CHD) risk by defining its calculation and reviewing studies of its superiority relative to serum triglycerides and LDL-C as a CHD risk predictor and goal for therapy.

  • Heartsick America. Cowley, Geoffrey // Bulletin with Newsweek;05/29/2001, Vol. 119 Issue 6276, p96 

    Reports on the National Heart, Lung & Blood Institute study on the effect of lowering high blood cholesterol levels on the risk of coronary heart disease. Low density lipoprotein (LDL) limits recommended for different groups of people; Usefulness of drugs in preventing heart attacks by lowering...

  • Monoclonal Antibody to PCSK9 Offers New Approach to Treating Hypercholesterolemia. Lederman, Lynne // MD Conference Express;Aug2013, Vol. 13 Issue 7, p16 

    Hypercholesterolemia, particularly an increased level of low-density lipoprotein cholesterol (LDL-C) is associated with elevated cardiovascular (CV) risk. Individuals with genetic lifelong lower levels of LDL-C are associated with a reduced risk of CV events. In addition, the reduction in...

  • Relative Importance of Various Risk Factors for Asymptomatic Carotid Atherosclerosis versus Coronary Heart Disease Incidence: The Atherosclerosis Risk In Communities Study. Sharrett, A. R.; Sorlie, P. D.; Chambless, L E.; Folsom, A. R.; Hutchinson, R. G.; Heiss, G.; Szklo, M. // American Journal of Epidemiology;1999, Vol. 149 Issue 9, p843 

    Major risk factors for coronary heart disease are also associated with early carotid artery thickening, but no studies have yet examined patterns of risk factors to see whether they differ for the two outcomes. Assuming similar pathogenesis for both coronary and carotid atherosclerosis, one...

  • Implementing the new ATP III cholesterol guidellines.  // Patient Care;Nov2002, Vol. 36 Issue 13, p19 

    Presents guidelines for clinical cholesterol management recommended by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, also known as Adult Treatment Panel (ATP) III, released in May 2001. ...

  • Heartsick America. Cowley, Geoffrey // Newsweek (Pacific Edition);05/28/2001 (Pacific Edition), Vol. 137 Issue 22, p63 

    Discusses the findings of a federal report on the benefits of cholesterol reduction. Recommendation of drug use to reduce high cholesterol levels; Reduction of risk for coronary heart disease; Different limits which were recommended on low-density lipoproteins (LDL) cholesterol.

  • Heartsick America. Cowley, Geoffrey // Newsweek;5/28/2001, Vol. 137 Issue 22, p43 

    Discusses the findings of a federal report which state benefits of cholesterol reduction. Recommendation of drug use to reduce high cholesterol levels; Reduction of risk for coronary heart disease; Different limits which were recommended on low-density lipoproteins (LDL) cholesterol.

  • Heartsick America. Cowley, Geoffrey // Newsweek (Atlantic Edition);05/28/2001 (Atlantic Edition), Vol. 137 Issue 22, p63 

    Discusses the findings of a federal report on the benefits of cholesterol reduction. Recommendation of drug use to reduce high cholesterol levels; Reduction of risk for coronary heart disease; Different limits which were recommended on low-density lipoproteins (LDL) cholesterol.

  • How The Public Continues To Be Deceived.  // Health & Stress;2004, Issue 1, p6 

    Examines the link between coronary heart disease and elevated low density lipoprotein. Evidence from Atkins diet and other studies showing that a high fat diet can actually reduce weight and lipid levels; Persistence of the diet-cholesterol-coronary dogma; Association between falling...

Share

Read the Article

Courtesy of NEW JERSEY STATE LIBRARY

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics