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- Title
The impact of concordant and discordant conditions on the quality of care for hyperlipidemia.
- Authors
Lagu, Tara; Weiner, Mark G.; Hollenbeak, Christopher S.; Eachus, Susan; Roberts, Craig S.; Schwartz, J. Sanford; Turner, Barbara J.
- Abstract
<bold>Background: </bold>Physician treatment of cardiovascular risk factors may be affected by specific types of patient comorbidities.<bold>Objectives: </bold>To examine the relationship between discordant comorbidities and LDL-cholesterol management in hypertensive patients not previously treated with lipid-lowering therapy; to determine whether the presence of cardiovascular (concordant) conditions mediates this relationship.<bold>Design: </bold>We performed a retrospective cohort study of 1,935 hypertensive primary care patients (men >45 years of age, women >55 years of age) with documented elevated low-density lipoprotein (LDL) cholesterol and no lipid-lowering therapy at baseline. The outcome was guideline-consistent hyperlipidemia management defined as optimal value on repeat LDL cholesterol testing or initiation of lipid-lowering therapy. Using generalized estimating equations (GEE), we examined the association of concordant and discordant comorbidities with guideline-consistent hyperlipidemia management over a 2-year follow-up period, adjusting for patient characteristics.<bold>Results: </bold>Guideline-consistent hyperlipidemia management was achieved in 1,236 patients (64%). In the fully adjusted model, each additional discordant condition resulted in a 19% lower adjusted odds ratio of guideline-consistent hyperlipidemia management (p < 0.001) when compared with no discordant conditions. The dampening effect of discordant conditions on guideline-consistent management persisted even in the presence of concordant conditions, but each additional concordant condition was associated with a 37% increase in the adjusted odds of guideline-consistent hyperlipidemia management (p < 0.001).<bold>Conclusions: </bold>In this cohort of hypertensive primary care patients, the number of conditions discordant with cardiovascular risk was strongly negatively associated with guideline-consistent hyperlipidemia management even in patients at the highest risk for cardiovascular events and cardiac death.
- Subjects
CARDIOVASCULAR diseases risk factors; HYPERTENSION; PATIENTS; PHYSICAL therapy; COMORBIDITY; PRIMARY care; DRUG therapy for hyperlipidemia; MEDICAL quality control; RESEARCH; FERRANS &; Powers Quality of Life Index; RESEARCH methodology; RETROSPECTIVE studies; LDL cholesterol; MEDICAL cooperation; EVALUATION research; HYPERLIPIDEMIA; MEDICAL protocols; PRIMARY health care; RISK assessment; COMPARATIVE studies; IMPACT of Event Scale; DISEASE complications
- Publication
JGIM: Journal of General Internal Medicine, 2008, Vol 23, Issue 8, p1208
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-008-0647-4