Institutional, provider, and patient correlates of low-density lipoprotein and non–high-density lipoprotein cholesterol goal attainment according to the Adult Treatment Panel III guidelines - 06/08/11
, LeChauncy D. Woodard, MD, MPH a, Cassie R. Landrum, MPH a, Kenneth Pietz, PhD a, Degang Wang, PhD a, Christie M. Ballantyne, MD b, Laura A. Petersen, MD, MPH aRésumé |
Background |
The aim of this analysis was to identify the proportion of coronary heart disease (CHD) patients achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol (non–HDL-C) goals and to identify correlates of dual goal attainment.
Methods |
We analyzed patient, provider, and facility characteristics for 21,801 CHD patients in one Veterans Affairs Hospitals Network.
Results |
Low-density lipoprotein cholesterol goal attainment was 80%, but optional LDL-C goal attainment was 41%. Of patients with triglycerides ≥200 mg/dL, 51% attained both LDL-C and non–HDL-C goals. Correlates of higher dual goal attainment included older age (65-74 years: odds ratio [OR] 1.47, 95% CI 1.28-1.69), diabetes (OR 1.33, 95% CI 1.16-1.53), obesity (OR 1.25, 95% CI 1.04-1.50), a higher number of primary care visits (OR 1.04, 95% CI 1.04-1.05), and mild increase in illness severity of patients in provider's panel (OR 1.20, 95% CI 1.0008-1.46), whereas African American patients were less likely to achieve dual lipid goals (OR 0.63, 95% CI 0.48-0.82). Receipt of care from physician (vs nonphysician) or specialist (vs primary care) provider, number of patients in provider's panel, and percentage of patients in provider's panel with diagnosis of hyperlipidemia were not associated with dual goal attainment.
Conclusions |
A large proportion of CHD patients attained LDL-C goal, but optional LDL-C goal attainment was low. Patients with elevated triglycerides had poor attainment of dual LDL-C and non–HDL-C goals, suggesting a treatment gap. Factors associated with dual goal attainment may identify interventions needed to improve future guideline adherence.
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| This work was supported by Investigator Initiated Research funding by Merck and Co, Inc, as well as the Houston VA Health Services Research & Development Center of Excellence (grant HFP90-020). Dr Virani is supported by a Department of Veterans Affairs Health Services Research and Development Service (HSR&D) Career Development Award (CDA-09-028). This work was also supported in part by VA HSR&D PPO 09-316 (PI LeChauncy D. Woodard, MD, MPH), VA HSR&D IIR 04-349 (PI Laura A. Petersen, MD, MPH), andNIH R01 HL079173-01 (PI Laura A. Petersen, MD, MPH) and a VA contract (Project XVA 33-120) at the request of Veterans Integrated Service Networks 1, 12, and 23. Dr Petersen was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar (045444) and an American Heart Association Established Investigator Awardee (0540043N) at the time this work was conducted. |
Vol 161 - N° 6
P. 1140-1146 - juin 2011 Retour au numéro
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