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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Cardiology management improves secondary prevention measures among patients with coronary artery disease

P. Michael Ho, MD^*,*, Frederick A. Masoudi, MD, MSPH, FACC, Eric D. Peterson, MD, MPH, FACC, Gary K. Grunwald, PhD^||, Anne E. Sales, PhD^¶, Karl E. Hammermeister, MD and John S. Rumsfeld, MD, PhD, FACC

^* Health Services Research, Denver, Colorado, USA
Cardiology and Health Services Research, Denver Veteran Affairs Medical Center, University of Colorado Health Sciences Center, Denver, Colorado, USA
Cardiology Division, Denver Health Medical Center, Divisions of Cardiology and Geriatric Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
Cardiovascular Outcomes and Quality, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
^|| Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado, USA
^¶ Ischemic Heart Disease Quality Enhancement Research Initiative (IHD-QUERI), Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA

Manuscript received October 13, 2003; revised manuscript received December 8, 2003, accepted December 15, 2003.

^* Reprint requests and correspondence: Dr. P. Michael Ho, 1055 Clermont Street (111B), Denver, Colorado 80220, USA.
Michael.ho{at}uchsc.edu

OBJECTIVES: The goal of this study was to determine if cardiology subspecialty involvement improves the attainment of recommended low-density lipoprotein (LDL) cholesterol and blood pressure (BP) targets in coronary artery disease (CAD) patients.

BACKGROUND: The impact of physician specialty on secondary prevention measures for CAD in ambulatory care is unknown.

METHODS: This was a retrospective cohort study of 13,995 patients with CAD seen at eight ambulatory care Veteran Affairs facilities from 1998 to 2000. Patients with cardiology involvement were defined as those seen in cardiology clinic in addition to primary care. The main outcomes of interest were LDL cholesterol 100 mg/dl and BP 130/85 mm Hg. Multivariable hierarchical regression analyses were used to determine the independent association of cardiology involvement with improved LDL cholesterol and BP control.

RESULTS: Overall, 3,771 (27.0%) patients had cardiology involvement. A higher proportion of patients with cardiology involvement achieved LDL cholesterol (55.6% vs. 45.6%; p < 0.01) and BP (45.3% vs. 35.9%; p < 0.01) goals. In multivariable hierarchical regression analysis, cardiology involvement was independently associated with better LDL cholesterol (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.40 to 1.82) and BP (OR, 1.52; 95% CI, 1.32 to 1.77) control. The benefit of cardiology involvement was consistent across a range of LDL and BP targets, in analysis of LDL and BP as continuous outcomes, and among subgroups of high-risk patients, including diabetic patients, the elderly, and those with prior revascularization.

CONCLUSIONS: Cardiology involvement is associated with better LDL cholesterol and BP control among CAD patients. However, significant room for improvement in secondary prevention measures remains, irrespective of physician specialty.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ACS = acute coronary syndrome   AMI = acute myocardial infarction   BP = blood pressure   CABG = coronary artery bypass graft   CAD = coronary artery disease   CI = confidence interval   ICD-9 = International Classification of Diseases- 9th revision   LDL = low-density lipoprotein   OPC = outpatient care file   OR = odds ratio   PCI = percutaneous coronary intervention   PTF = patient treatment file   VA = Veterans Affairs

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