1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Modifying Therapy When CV Risk Factors Are Poorly Controlled

Assessing appropriate therapy modification by clinicians might be a way to measure quality of care.

When patients have poorly controlled cardiovascular risk factors, how often is therapy modified accordingly? Researchers addressed this question by retrospectively studying data from 253,238 adults with poorly controlled hypertension, dyslipidemia, or diabetes enrolled in Kaiser Permanente of Northern California from July 2002 through December 2003. This cohort with poorly controlled risk factors represented 39% of enrollees who had at least one of the three conditions.

Levels of poor control were defined according to individuals’ risk status and coexisting conditions. Therapy modification was defined as increasing the dosage of at least one relevant medication, increasing the number of drug classes used, or switching to a drug in a different class. "Appropriate care" was defined as therapy modification or return to control without modification.

Therapy was modified within 3 months in 54% of patients with poorly controlled systolic BP, 63% with poorly controlled diastolic BP, 47% with poorly controlled LDL cholesterol, and 57% with poorly controlled hemoglobin A_1C levels. By 6 months, most patients were in the appropriate care category: 71%, 82%, 59%, and 70%, respectively. The most common therapy modifications were increasing the number of drug classes and increasing dosages.

Higher baseline risk-factor levels, having more than one of the studied conditions, and previous CAD or target-organ damage were independently associated with appropriate care within 6 months. Appropriate care was more common in women than in men for all poorly controlled risk factors except systolic BP, and more common in older than in younger patients only for poorly controlled diastolic BP and LDL cholesterol.

Comment: In this fully integrated healthcare delivery system in California, most patients with poorly controlled cardiovascular risk factors either had their therapy modified or returned to control without modification. The positive changes were better than in previous studies but still not optimal, especially with regard to LDL cholesterol. Also, therapy modification was not studied in relation to clinical outcomes. Nevertheless, this new quality measure holds promise for encouraging quality-of-care improvements.

— Joel M. Gore, MD

Published in Journal Watch Cardiology May 4, 2006

Citation(s):

Rodondi N et al. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann Intern Med 2006 Apr 4; 144:475-84.

• Original article (Subscription may be required)
• Medline abstract (Free)

Perlin JB and Pogach LM. Improving the outcomes of metabolic conditions: Managing momentum to overcome clinical inertia. Ann Intern Med 2006 Apr 4; 144:525-7.

• Original article (Subscription may be required)
• Medline abstract (Free)

2011 Top Stories