Maintenance of cardiovascular risk goals in veterans with diabetes after discharge from a cardiovascular risk reduction clinic

• Published in: Preventive cardiology Vol. 12; no. 1; p. 3
• Main Authors: Pirraglia, Paul A, Taveira, Tracey H, Cohen, Lisa B, Dooley, Andrea, Wu, Wen-Chih
• Format: Journal Article
• Language: English
• Published: United States 2009
• Subjects: Aged; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; Female; Hospitals, Veterans; Humans; Incidence; Male; Outcome Assessment (Health Care) - methods; Patient Discharge; Retrospective Studies; Risk Assessment - methods; Survival Rate; United States - epidemiology; Veterans; United States
• ISSN: 1520-037X
• DOI: 10.1111/j.1751-7141.2008.00017.x

The authors evaluated maintenance of achieved cardiovascular risk control after discharge from a pharmacist-coordinated cardiovascular risk reduction clinic. Using data from 2001 to 2004 divided by financial quarters (ie, 3-month periods), the authors performed survival analysis of diabetic patients who had attained at least one cardiovascular risk goal in the clinic. Mean times to failure were 7.1 +/- 0.21 quarters for hemoglobin A1c, 7.6 +/- 0.29 quarters for low-density lipoprotein cholesterol (LDL-C), and 2.5 +/- 0.24 quarters for systolic blood pressure (SBP). Body mass index predicted glycemic control failure (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.01-1.15; P = .02), insulin use predicted LDL-C control failure (HR, 3.08; 95% CI, 1.15-8.22; P = .03), and baseline SBP predicted SBP control failure (HR, 1.02; 95% CI, 1.01-1.03; P = .0003). The authors found good durability of effect for most cardiovascular risk targets. Worse control at entry predicted failure after successful attainment of a cardiovascular goal. More sustained attention or booster interventions for patients with worse control at entry may be necessary.