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

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BMC Cardiovascular Disorders

, 6:6

First Online: 09 February 2006Received: 02 August 2005Accepted: 09 February 2006DOI: 10.1186-1471-2261-6-6

Cite this article as: Ho, P.M., Prochazka, A.V., Magid, D.J. et al. BMC Cardiovasc Disord 2006 6: 6. doi:10.1186-1471-2261-6-6


BackgroundHyperlipidemia 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.

MethodsThis 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.

ResultsOf 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.

ConclusionGuideline 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.

List of abbreviationsACSAcute Coronary Syndrome

BPBlood pressure

CABGCoronary Artery Bypass Graft

DBPDiastolic blood pressure

IHDIschemic heart disease

ICD-9International Classification of Diseases-9th revision diagnosis

LDLLow density lipoprotein

OPCOutpatient Care File

PTFPatient Treatment File

PCIPercutaneous Coronary Intervention

SBPSystolic blood pressure

VADepartment of Veteran Affairs

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-6-6 contains supplementary material, which is available to authorized users.

P Michael Ho, Allan V Prochazka and John S Rumsfeld contributed equally to this work.

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Author: P Michael Ho - Allan V Prochazka - David J Magid - Anne E Sales - Gary K Grunwald - Karl E Hammermeister - John S Ru


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