Abstract:
BACKGROUND:Adherence to recommended guidelines in the care for diabetes has been demonstrated to significantly prevent the excess risk of hospitalization and mortality for cardiovascular diseases. Aim of this study was to evaluate whether adherence to a standardized process quality-of-care-indicator in diabetes, is able to predict, equally in men and women, first hospitalization or mortality risk after acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of above major adverse cardiovascular events (MACE). METHODS:Guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was measured in the year 2006 in 91 826 (46 167 M/45 659 F) diabetic patients, living in Tuscany (Italy). By a Cox-proportional hazard regression model, the effect of GCI adherence was assessed on adjusted hospitalization mortality risk for AMI, IS, CHF, LEA and MACE in both genders in a follow-up period of 6 years (2007-12). RESULTS:After adjusting for covariates, adherence to CGI exerted a significant positive effect on AMI, CHF and LEA outcomes among men, whereas among women, GCI adherence significantly decreased hospitalization risk only for CHF and mortality risk after IS. Finally, GCI adherence significantly reduced hospitalization risk for MACE of about 15% and 11% in men and women, respectively. On the contrary, GCI adherence seemed to have no significant influence on mortality risk after hospitalization for MACE in both genders. CONCLUSION:In this cohort, over a 6-year follow-up, GCI adherence was found to be a significant predictor of lower cardiovascular risk, with some evident gender differences.
journal_name
Eur J Public Healthjournal_title
European journal of public healthauthors
Seghieri C,Policardo L,Francesconi P,Seghieri Gdoi
10.1093/eurpub/ckv159subject
Has Abstractpub_date
2016-04-01 00:00:00pages
219-24issue
2eissn
1101-1262issn
1464-360Xpii
ckv159journal_volume
26pub_type
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