Abstract 17864: Suboptimal Longitudinal Risk Factor Control Following Coronary Revascularization in a Commnity Setting
Introduction: Longitudinal management of cardiac risk factors is central to secondary prevention following coronary revascularization. Traditionally, quality metrics for revascularization focus on short-term outcomes like readmission and procedural complications. Linkage of electronic health records (EHRS) across inpatient and outpatient settings makes it possible to follow risk factors longitudinally to monitor control. Our objective is to describe blood pressure (BP) and low-density lipoprotein (LDL) control at 6 months following coronary revascularization in a community setting.
Methods: We conducted a retrospective cohort study of patients who received coronary revascularization between 2010-2012 at a large academic community hospital. We obtained BP and LDL records by linking clinical records from a large primary care network and a single large cardiology practice, both of which are affiliated with the hospital but on separate EHR platform. We used logistic regression to determine predictors of control at 6 months.
Results: Overall, 2,099 patients had revascularization during our study period, including 1,589 with PCI and 464 with CABG (22 had both PCI and CABG). Of these, 441 had an available BP and 424 had an available LDL at 6 months. The average BP was 128/73, with 97 (22%) having a BP above 140/90. The average LDL was 84, with 96 (23%) having an LDL above 100. Of the 157 patients with BP and LDL data, 6% (10) were out of control for both measures. Overall, predictors of poor BP control included female gender (OR = 1.6, 95% CI = 1.0-2.6) and non-white race (OR = 1.8, 95% CI = 1.1-3.2). Non-white race was the only significant predictor of poor LDL control (OR = 2.4, 95% CI = 1.4-4.2).
Discussion: In our community cohort of patients who had followup of BP or LDL at 6 months following revascularization, we found that 1 in 5 were not at goal for BP or LDL control. Our results suggest significant opportunity for improvement of risk factor control in secondary prevention, and highlight the potential value of linking EHRs to track longitudinal outcomes across clinical settings.
- © 2013 by American Heart Association, Inc.