Abstract 3861: Multiple Lipid Goal Attainment and Improved Cardiovascular Outcomes with Lipid-Modifying Therapy: Analysis of a Collaborative Practice Model versus a General/Specialty Practice Model
Purpose: This analysis compares drug therapy to achieve optimal lipid profiles (LP) and improve cardiovascular (CV) outcomes in patients (pts) treated in a collaborative practice model (CPM) with those treated in a general/specialty practice model (GSPM). We tested the hypothesis that CPM treated pts achieve better LP goals and have reduced CV events.
Methods: CPM is a cardiologist-nurse model. This is a retrospective cohort analysis of CPM (n = 524) and an integrated, managed-care database, GSPM (n = 35,911). All pts had a LP between 1/1/00 – 12/31/03; had a minimum 12 months health plan eligibility pre-and post-baseline LP; and are defined as primary or secondary risk based on ICD-9 and CPT codes and pharmacy records. Optimal LP values are based on NCEP ATP III goals and AHA recommendations for women. Laboratory values, drug therapy and CV events are assessed from the time of the initial LP for a follow-up of up to 5 years.
Results: More CPM pts are categorized as secondary risk and have a greater burden of dyslipidemia. Drug therapy (%) in CPM is: none 9, statin 24, niacin 12 and combination 55; GSPM (% initial therapy): none 68, statin 26, niacin 1 and combination 4. The % of pts at LP goals (CPM vs. GSPM) is reported in the graph (LDL-C, nonHDL-C, HDL-C, TG and the simultaneous achievement of all three lipids based on risk). The results favor CPM compared to GSPM in all categories (p < .0001). The mean TC/HDL ratio is 3.6 (+/− 1.25) for CPM and 4.4 (+/− 1.28) for GSPM (p < .0001). CV events occurred in 1.7% in the CPM vs. 13.5% in the GSPM (p < .0001).
Conclusion: This analysis provides data supporting that CPM is more effective at LP target attainment and reduction of CV events, consistent with AHA recommendations.