Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease
Background Although current performance measures define low-density-lipoprotein cholesterol (LDL-C) levels
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| Veröffentlicht in: | The American heart journal 2011-10, Vol.162 (4), p.725-732.e1 |
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| creator | Virani, Salim S., MD Woodard, LeChauncy D., MD, MPH Chitwood, Supicha S., MPH Landrum, Cassie R., MPH Urech, Tracy H., MPH Wang, Degang, PhD Murawsky, Jeffrey, MD Ballantyne, Christie M., MD, FACC Petersen, Laura A., MD, MPH, FACP |
| description | Background Although current performance measures define low-density-lipoprotein cholesterol (LDL-C) levels |
| doi_str_mv | 10.1016/j.ahj.2011.07.013 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_903660074</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0002870311005552</els_id><sourcerecordid>903660074</sourcerecordid><originalsourceid>FETCH-LOGICAL-c465t-8227a6a7a0a5aaf75c3a41b4617d336775cff96cee09c5178a9b05d67d02bc5c3</originalsourceid><addsrcrecordid>eNp9ktGLEzEQxhdRvN7pH-CLBER8ap1kd5NdBEEOT4UDH9TnMM3O0tR0U5O0Rx_8353S6sE9-BQy_L5hvvmmql5IWEiQ-u16gav1QoGUCzALkPWjaiahN3NtmuZxNQMANe8M1BfVZc5r_mrV6afVhZJ9p7TWs-r3TaJfO5rcQeA0CBdTooCFsoijKImwbGgqwk-FpuxH77D4OIkxJkGB9kyyaBUD5UIpBsE1Cpl5sWWSpVnc-bISDtPg4x6z2wVMYvCZMNOz6smIIdPz83tV_bj5-P368_z266cv1x9u567RbZl3ShnUaBCwRRxN62ps5LLR0gx1rQ0XxrHXjgh610rTYb-EdtBmALV0TF9Vb059tymy21zsxmdHIeBEcZdtD7XWAKZh8tUDch13aeLhrGwb03WdlJIpeaJcijknGu02-Q2mg5Vgj9HYteVo7DEaC8ZyNKx5ee68W25o-Kf4mwUDr88AbwnDmHByPt9zbFdB3zP37sTxomnvKdnseNOOBp_IFTtE_98x3j9Qu-AnzjX8pAPle7c2Kwv22_GGjickJUDbtqr-A0rYwqY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1547888111</pqid></control><display><type>article</type><title>Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Virani, Salim S., MD ; Woodard, LeChauncy D., MD, MPH ; Chitwood, Supicha S., MPH ; Landrum, Cassie R., MPH ; Urech, Tracy H., MPH ; Wang, Degang, PhD ; Murawsky, Jeffrey, MD ; Ballantyne, Christie M., MD, FACC ; Petersen, Laura A., MD, MPH, FACP</creator><creatorcontrib>Virani, Salim S., MD ; Woodard, LeChauncy D., MD, MPH ; Chitwood, Supicha S., MPH ; Landrum, Cassie R., MPH ; Urech, Tracy H., MPH ; Wang, Degang, PhD ; Murawsky, Jeffrey, MD ; Ballantyne, Christie M., MD, FACC ; Petersen, Laura A., MD, MPH, FACP</creatorcontrib><description>Background Although current performance measures define low-density-lipoprotein cholesterol (LDL-C) levels <100 mg/dL in patients with cardiovascular disease (CVD) as good quality, they provide a snapshot and do not address whether treatment intensification was performed to manage elevated LDL-C levels. Methods We determined the proportion of patients with CVD (n = 22,888) with LDL-C <100 mg/dL and the proportion with uncontrolled LDL-C levels (≥100 mg/dL) who received treatment intensification within the 45-day follow-up in a Veterans Affairs Network. We evaluated facility, provider, and patient correlates of treatment intensification. Results Low-density-lipoprotein cholesterol levels were at goal in 16,350 (71.4%) patients. An additional 2,093 (one third of those eligible for treatment intensification) received treatment intensification. Controlling for clustering between facilities and patient's illness severity: history of diabetes (odds ratio [OR] 1.15, 95% CI 1.01-1.32), hypertension (OR 1.19, 95% CI 1.01-1.42), good medication adherence (OR 2.20, 95% CI 1.91-2.54), and a higher number of lipid panels (OR 1.20, 95% CI 1.14-1.27) were associated with treatment intensification. Patients older than 75 years (OR 0.65, 95% CI 0.56-0.75) and women (OR 0.66, 95% CI 0.43-1.00) were less likely to receive treatment intensification. Teaching status of the facility, physician or specialist primary care provider, and patient's race were not associated with treatment intensification. Conclusions Only one third of the CVD patients with elevated LDL-C received treatment intensification. Diabetic and hypertensive patients were more likely to receive treatment intensification, whereas, older patients, female patients, and patients with poor medication adherence were less likely to receive treatment intensification. Our findings highlight areas for quality improvement initiatives.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2011.07.013</identifier><identifier>PMID: 21982666</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - complications ; Cholesterol ; Cholesterol, LDL - blood ; Coronary vessels ; Drug therapy ; Female ; Heart attacks ; Humans ; Hypercholesterolemia - complications ; Hypercholesterolemia - drug therapy ; Male ; Medical sciences ; Middle Aged</subject><ispartof>The American heart journal, 2011-10, Vol.162 (4), p.725-732.e1</ispartof><rights>Mosby, Inc.</rights><rights>2011 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c465t-8227a6a7a0a5aaf75c3a41b4617d336775cff96cee09c5178a9b05d67d02bc5c3</citedby><cites>FETCH-LOGICAL-c465t-8227a6a7a0a5aaf75c3a41b4617d336775cff96cee09c5178a9b05d67d02bc5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870311005552$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24612099$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21982666$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Virani, Salim S., MD</creatorcontrib><creatorcontrib>Woodard, LeChauncy D., MD, MPH</creatorcontrib><creatorcontrib>Chitwood, Supicha S., MPH</creatorcontrib><creatorcontrib>Landrum, Cassie R., MPH</creatorcontrib><creatorcontrib>Urech, Tracy H., MPH</creatorcontrib><creatorcontrib>Wang, Degang, PhD</creatorcontrib><creatorcontrib>Murawsky, Jeffrey, MD</creatorcontrib><creatorcontrib>Ballantyne, Christie M., MD, FACC</creatorcontrib><creatorcontrib>Petersen, Laura A., MD, MPH, FACP</creatorcontrib><title>Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Although current performance measures define low-density-lipoprotein cholesterol (LDL-C) levels <100 mg/dL in patients with cardiovascular disease (CVD) as good quality, they provide a snapshot and do not address whether treatment intensification was performed to manage elevated LDL-C levels. Methods We determined the proportion of patients with CVD (n = 22,888) with LDL-C <100 mg/dL and the proportion with uncontrolled LDL-C levels (≥100 mg/dL) who received treatment intensification within the 45-day follow-up in a Veterans Affairs Network. We evaluated facility, provider, and patient correlates of treatment intensification. Results Low-density-lipoprotein cholesterol levels were at goal in 16,350 (71.4%) patients. An additional 2,093 (one third of those eligible for treatment intensification) received treatment intensification. Controlling for clustering between facilities and patient's illness severity: history of diabetes (odds ratio [OR] 1.15, 95% CI 1.01-1.32), hypertension (OR 1.19, 95% CI 1.01-1.42), good medication adherence (OR 2.20, 95% CI 1.91-2.54), and a higher number of lipid panels (OR 1.20, 95% CI 1.14-1.27) were associated with treatment intensification. Patients older than 75 years (OR 0.65, 95% CI 0.56-0.75) and women (OR 0.66, 95% CI 0.43-1.00) were less likely to receive treatment intensification. Teaching status of the facility, physician or specialist primary care provider, and patient's race were not associated with treatment intensification. Conclusions Only one third of the CVD patients with elevated LDL-C received treatment intensification. Diabetic and hypertensive patients were more likely to receive treatment intensification, whereas, older patients, female patients, and patients with poor medication adherence were less likely to receive treatment intensification. Our findings highlight areas for quality improvement initiatives.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - blood</subject><subject>Cardiovascular Diseases - complications</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL - blood</subject><subject>Coronary vessels</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hypercholesterolemia - complications</subject><subject>Hypercholesterolemia - drug therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ktGLEzEQxhdRvN7pH-CLBER8ap1kd5NdBEEOT4UDH9TnMM3O0tR0U5O0Rx_8353S6sE9-BQy_L5hvvmmql5IWEiQ-u16gav1QoGUCzALkPWjaiahN3NtmuZxNQMANe8M1BfVZc5r_mrV6afVhZJ9p7TWs-r3TaJfO5rcQeA0CBdTooCFsoijKImwbGgqwk-FpuxH77D4OIkxJkGB9kyyaBUD5UIpBsE1Cpl5sWWSpVnc-bISDtPg4x6z2wVMYvCZMNOz6smIIdPz83tV_bj5-P368_z266cv1x9u567RbZl3ShnUaBCwRRxN62ps5LLR0gx1rQ0XxrHXjgh610rTYb-EdtBmALV0TF9Vb059tymy21zsxmdHIeBEcZdtD7XWAKZh8tUDch13aeLhrGwb03WdlJIpeaJcijknGu02-Q2mg5Vgj9HYteVo7DEaC8ZyNKx5ee68W25o-Kf4mwUDr88AbwnDmHByPt9zbFdB3zP37sTxomnvKdnseNOOBp_IFTtE_98x3j9Qu-AnzjX8pAPle7c2Kwv22_GGjickJUDbtqr-A0rYwqY</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Virani, Salim S., MD</creator><creator>Woodard, LeChauncy D., MD, MPH</creator><creator>Chitwood, Supicha S., MPH</creator><creator>Landrum, Cassie R., MPH</creator><creator>Urech, Tracy H., MPH</creator><creator>Wang, Degang, PhD</creator><creator>Murawsky, Jeffrey, MD</creator><creator>Ballantyne, Christie M., MD, FACC</creator><creator>Petersen, Laura A., MD, MPH, FACP</creator><general>Mosby, Inc</general><general>Mosby</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease</title><author>Virani, Salim S., MD ; Woodard, LeChauncy D., MD, MPH ; Chitwood, Supicha S., MPH ; Landrum, Cassie R., MPH ; Urech, Tracy H., MPH ; Wang, Degang, PhD ; Murawsky, Jeffrey, MD ; Ballantyne, Christie M., MD, FACC ; Petersen, Laura A., MD, MPH, FACP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c465t-8227a6a7a0a5aaf75c3a41b4617d336775cff96cee09c5178a9b05d67d02bc5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases - blood</topic><topic>Cardiovascular Diseases - complications</topic><topic>Cholesterol</topic><topic>Cholesterol, LDL - blood</topic><topic>Coronary vessels</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Hypercholesterolemia - complications</topic><topic>Hypercholesterolemia - drug therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Virani, Salim S., MD</creatorcontrib><creatorcontrib>Woodard, LeChauncy D., MD, MPH</creatorcontrib><creatorcontrib>Chitwood, Supicha S., MPH</creatorcontrib><creatorcontrib>Landrum, Cassie R., MPH</creatorcontrib><creatorcontrib>Urech, Tracy H., MPH</creatorcontrib><creatorcontrib>Wang, Degang, PhD</creatorcontrib><creatorcontrib>Murawsky, Jeffrey, MD</creatorcontrib><creatorcontrib>Ballantyne, Christie M., MD, FACC</creatorcontrib><creatorcontrib>Petersen, Laura A., MD, MPH, FACP</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Virani, Salim S., MD</au><au>Woodard, LeChauncy D., MD, MPH</au><au>Chitwood, Supicha S., MPH</au><au>Landrum, Cassie R., MPH</au><au>Urech, Tracy H., MPH</au><au>Wang, Degang, PhD</au><au>Murawsky, Jeffrey, MD</au><au>Ballantyne, Christie M., MD, FACC</au><au>Petersen, Laura A., MD, MPH, FACP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>162</volume><issue>4</issue><spage>725</spage><epage>732.e1</epage><pages>725-732.e1</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Although current performance measures define low-density-lipoprotein cholesterol (LDL-C) levels <100 mg/dL in patients with cardiovascular disease (CVD) as good quality, they provide a snapshot and do not address whether treatment intensification was performed to manage elevated LDL-C levels. Methods We determined the proportion of patients with CVD (n = 22,888) with LDL-C <100 mg/dL and the proportion with uncontrolled LDL-C levels (≥100 mg/dL) who received treatment intensification within the 45-day follow-up in a Veterans Affairs Network. We evaluated facility, provider, and patient correlates of treatment intensification. Results Low-density-lipoprotein cholesterol levels were at goal in 16,350 (71.4%) patients. An additional 2,093 (one third of those eligible for treatment intensification) received treatment intensification. Controlling for clustering between facilities and patient's illness severity: history of diabetes (odds ratio [OR] 1.15, 95% CI 1.01-1.32), hypertension (OR 1.19, 95% CI 1.01-1.42), good medication adherence (OR 2.20, 95% CI 1.91-2.54), and a higher number of lipid panels (OR 1.20, 95% CI 1.14-1.27) were associated with treatment intensification. Patients older than 75 years (OR 0.65, 95% CI 0.56-0.75) and women (OR 0.66, 95% CI 0.43-1.00) were less likely to receive treatment intensification. Teaching status of the facility, physician or specialist primary care provider, and patient's race were not associated with treatment intensification. Conclusions Only one third of the CVD patients with elevated LDL-C received treatment intensification. Diabetic and hypertensive patients were more likely to receive treatment intensification, whereas, older patients, female patients, and patients with poor medication adherence were less likely to receive treatment intensification. Our findings highlight areas for quality improvement initiatives.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>21982666</pmid><doi>10.1016/j.ahj.2011.07.013</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiology. Vascular system Cardiovascular Cardiovascular disease Cardiovascular Diseases - blood Cardiovascular Diseases - complications Cholesterol Cholesterol, LDL - blood Coronary vessels Drug therapy Female Heart attacks Humans Hypercholesterolemia - complications Hypercholesterolemia - drug therapy Male Medical sciences Middle Aged |
| title | Frequency and correlates of treatment intensification for elevated cholesterol levels in patients with cardiovascular disease |
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