Comorbidity complicates cardiovascular treatment: is diabetes the exception?
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E Nouwens1, J van Lieshout, M Wensing
1Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101/Geert Grooteplein 21, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands. e.nouwens@iq.umcn.nl
Insights
Patients with diabetes (DM) and cardiovascular disease (CVD) received better preventive care than those with CVD alone. However, chronic obstructive pulmonary disease (COPD) did not significantly improve cardiovascular risk management.
Area of Science:
- Cardiology
- Public Health
- Internal Medicine
Background:
- Many patients with cardiovascular disease (CVD) do not meet recommended lifestyle and treatment targets.
- The impact of comorbidities like diabetes (DM) and chronic obstructive pulmonary disease (COPD) on CVD risk management quality is not fully understood.
Purpose of the Study:
- To evaluate how the presence of diabetes (DM) and/or chronic obstructive pulmonary disease (COPD) affects the quality of cardiovascular risk management in patients with established CVD.
Main Methods:
- A review of 1614 medical records from 45 primary care practices in the Netherlands.
- Data collected on 20 performance indicators for CVD risk management.
- Descriptive and multilevel regression analyses were performed to compare patient groups.
Main Results:
- Patients with CVD and DM (22.4%) showed better risk management scores on 17 of 20 indicators compared to CVD-only patients.
- Patients with CVD, DM, and COPD (3.1%) had improved scores on 14 indicators.
- Patients with CVD and COPD (7.8%) showed improvements on only three indicators.
Conclusions:
- Diabetes (DM) is associated with more comprehensive cardiovascular risk management.
- Chronic obstructive pulmonary disease (COPD) does not appear to enhance cardiovascular risk management quality in CVD patients.
- Findings support the link between DM and improved preventive treatment for cardiovascular risk.
Background:
Many patients with cardiovascular disease do not attain the targets for health-related lifestyle and preventive treatment recommended in practice guidelines. The aim of this study was to assess the impact of diabetes (DM) and chronic obstructive pulmonary disease (COPD) on the quality of cardiovascular risk management in patients with established cardiovascular diseases (CVD).
Methods And Results:
Patients with established CVD were randomly selected in primary care practices using recorded diagnoses. Structured case forms were used to review data on 20 performance indicators concerning CVD from medical records. Descriptive and multilevel regression analyses were conducted. In 45 primary care practices with 106 physicians in the Netherlands, 1614 medical records of patients with CVD (37.9% women) were reviewed. A total of 1076 (66.7%) patients had recorded CVD only (reference group); 7.8% had CVD and COPD; 22.4% had CVD and DM; 3.1% patients had CVD, COPD and DM. Compared with the reference group, patients with CVD and DM yielded higher scores on 17 of 20 indicators; patients with CVD, DM and COPD on 14 indicators; and patients with CVD and COPD on three indicators. Of the patients with CVD and DM, fewer patients had LDL-cholesterol levels over 2.5 mmol/l (OR=0.36; 95% CI 0.26-0.50), more had antiplatelet drugs prescribed (OR=1.72; 95% CI 1.17-2.54), and more had systolic blood pressure measurement (OR=4.12; 95% CI 2.80-6.06).
Conclusions:
This study showed that DM but not COPD was associated with more comprehensive cardiovascular risk management. This finding adds to cumulating evidence that presence of DM is associated with better preventive treatment of cardiovascular risk.