title: Maintenance of cardiovascular risk goals in veterans with diabetes after discharge from a cardiovascular risk reduction clinic.
abstract: 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.
authors.affiliation: Systems, Outcomes, and Quality in Chronic Disease and Rehabilitation (SOQCR) Program, Providence VA Medical Center, 830 Chalkstone Avenue, Building T32, Providence, RI 02908-4799, USA. paul.pirraglia@va.gov
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Tracey H
authors.initials: TH
authors.lastname: Taveira
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Cohen
authors.forename: Andrea
authors.initials: A
authors.lastname: Dooley
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014728:Veterans