The impact of concordant and discordant conditions on the quality of care for hyperlipidemia

Tara Lagu*, Mark G. Weiner, Christopher S. Hollenbeak, Susan Eachus, Craig S. Roberts, J. Sanford Schwartz, Barbara J. Turner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

BACKGROUND: Physician treatment of cardiovascular risk factors may be affected by specific types of patient comorbidities. OBJECTIVES: To examine the relationship between discordant comorbidities and LDL-cholesterol management in hypertensive patients not previously treated with lipid-lowering therapy; to determine whether the presence of cardiovascular (concordant) conditions mediates this relationship. DESIGN: We performed a retrospective cohort study of 1,935 hypertensive primary care patients (men >45 years of age, women >55 years of age) with documented elevated low-density lipoprotein (LDL) cholesterol and no lipid-lowering therapy at baseline. The outcome was guideline-consistent hyperlipidemia management defined as optimal value on repeat LDL cholesterol testing or initiation of lipid-lowering therapy. Using generalized estimating equations (GEE), we examined the association of concordant and discordant comorbidities with guideline-consistent hyperlipidemia management over a 2-year follow-up period, adjusting for patient characteristics. RESULTS: Guideline-consistent hyperlipidemia management was achieved in 1,236 patients (64%). In the fully adjusted model, each additional discordant condition resulted in a 19% lower adjusted odds ratio of guideline-consistent hyperlipidemia management (p<0.001) when compared with no discordant conditions. The dampening effect of discordant conditions on guideline-consistent management persisted even in the presence of concordant conditions, but each additional concordant condition was associated with a 37% increase in the adjusted odds of guideline-consistent hyperlipidemia management (p<0.001). CONCLUSIONS: In this cohort of hypertensive primary care patients, the number of conditions discordant with cardiovascular risk was strongly negatively associated with guideline-consistent hyperlipidemia management even in patients at the highest risk for cardiovascular events and cardiac death.

Original languageEnglish (US)
Pages (from-to)1208-1213
Number of pages6
JournalJournal of general internal medicine
Volume23
Issue number8
DOIs
StatePublished - Aug 2008
Externally publishedYes

Keywords

  • Comorbidity
  • Hyperlipidemia
  • Quality of care

ASJC Scopus subject areas

  • Internal Medicine

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