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.
journal_name
BMC Cardiovasc Disordjournal_title
BMC cardiovascular disordersauthors
Ho PM,Prochazka AV,Magid DJ,Sales AE,Grunwald GK,Hammermeister KE,Rumsfeld JSdoi
10.1186/1471-2261-6-6keywords:
subject
Has Abstractpub_date
2006-02-09 00:00:00pages
6issn
1471-2261pii
1471-2261-6-6journal_volume
6pub_type
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pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:2018-02-07 00:00:00
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pub_type: 杂志文章
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更新日期:2013-06-10 00:00:00
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pub_type: 杂志文章,meta分析
doi:10.1186/s12872-017-0686-z
更新日期:2017-10-05 00:00:00
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章
doi:10.1186/1471-2261-4-20
更新日期:2004-11-01 00:00:00
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doi:10.1186/s12872-017-0528-z
更新日期:2017-04-04 00:00:00
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doi:10.1186/s12872-017-0568-4
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pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2019-05-02 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1186/s12872-020-01478-1
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pub_type: 杂志文章
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更新日期:2020-12-09 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2012-06-08 00:00:00