Abstract P150: Modest Achievement of Guideline-Derived Treatment Goals in Diabetic Patients with Atherosclerotic Cardiovascular Disease Despite High Use of Guideline-Based Therapies

Abstract

Background: Recent emphasis has been placed on enhancing quality of cardiovascular care using practice guidelines and health information technology to provide feedback to individual physicians. How effective this has been in achieving treatment goals versus percent of appropriate patients receiving guideline-based therapy is unclear. Accordingly, the purpose of this study was to determine how successfully guideline-derived treatment goals were met for outpatients with diabetes (DM) and ASCVD in an academic general cardiology practice with an electronic medical record (EMR). Methods: A retrospective study was conducted on all outpatients managed in an academic general cardiology clinic who had diagnoses of both ASCVD and DM and had ≥ 2 outpatient visits between January 2008 and September 2009 (n =926), during which time EMR quarterly “report cards” were provided. Values for LDL, HDL, BP and BMI were abstracted for the first and last visits during the study period. Analysis was conducted on the percent of patients achieving treatment goals at each visit and differences in values between first and last visit. Results: A high percentage of patients were receiving guideline-based drug therapy at their last visit: Statin - 91.0%; Anti-hypertensive, ACE or ARB - 83.4%; Anti-platelet - 92.0%; β-blocker - 75.7%. However, mean LDL at the last visit was 80.4±33.7, and although 81% (649/797) had an LDL-C <= 100 mg/dl, only 41% (326/797) achieved an LDL-C <= 70mg/dl. Similarly, only 61% (563/921) achieved a systolic BP <= 130 mmHg, and mean reduction of BMI between the first and last visit was 1.3% (32.5±11.5 vs. 32.1±9.4, p=NS). The same number of patients gained 10% or more weight during the study period, as lost 10% or more weight, 5.3% (47/886). Conclusion: A very high percentage of patients were receiving guideline-based drugs, but with respect to achieving ATP III target LDL-C and systolic BP goals, there was less success. The greatest difficulty was in achieving weight loss. These results are similar to those achieved by randomized patients in the BARI-2D trial. In both studies, successful weight loss and achievement of LDL-C guidelines by ATP III were suboptimal although the use of appropriate therapy was high. Additional strategies are needed to achieve these targets.