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The association between processes, structures and outcomes of secondary prevention care among VA ischemic heart
P Michael Ho1, Allan V Prochazka, David J Magid
1Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA. michael.ho@uchsc.edu
Insights
Secondary prevention guideline adherence for ischemic heart disease (IHD) patients is suboptimal. Quality improvement efforts are needed to improve LDL cholesterol and blood pressure control, reducing cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Ischemic heart disease (IHD) patients face high risks of recurrent cardiovascular events due to hyperlipidemia and hypertension.
- Current adherence to national guidelines for LDL cholesterol and blood pressure management in IHD patients is inadequate.
- Optimizing secondary prevention is crucial for reducing morbidity and mortality in this population.
Purpose of the Study:
- To determine the rates of concordance with LDL cholesterol and blood pressure guidelines among veterans with IHD.
- To identify patient-specific factors, care processes, and healthcare structures associated with guideline adherence.
Main Methods:
- A cross-sectional study involving 14,114 veterans with IHD across 8 VA hospitals.
- Assessed concordance with LDL cholesterol (<100 mg/dl) and blood pressure (<140/90 mm Hg) recommendations.
- Employed cumulative logit and hierarchical logistic regression to identify factors associated with concordance.
Main Results:
- Only 21.9% of IHD patients met both LDL cholesterol and blood pressure guideline targets.
- Older age and vascular disease were linked to poorer adherence, while diabetes showed better adherence.
- Increased outpatient visits, medication prescriptions, and recent cardiac hospitalization correlated with improved adherence.
Conclusions:
- Guideline adherence for secondary prevention in ischemic heart disease patients remains suboptimal.
- Findings highlight the need for targeted quality improvement initiatives.
- Enhancing secondary prevention strategies can significantly reduce adverse cardiovascular outcomes in IHD patients.
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.
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