title: The COSEHC™ Global Vascular Risk Management quality improvement program: first follow-up report.
abstract: The Global Vascular Risk Management (GVRM) Study is a 5-year prospective observational study of 87,863 patients (61% females) with hypertension and associated cardiovascular risk factors began January 1, 2010. Data are gathered electronically and cardiovascular risk is evaluated using the Consortium for Southeastern Hypertension Control™ (COSEHC™)-11 risk score. Here, we report the results obtained at the completion of 33 months since study initiation. De-identified electronic medical records of enrolled patients were used to compare clinical indicators, antihypertensive medication usage, and COSEHC™ risk scores across sex and diabetic status subgroups. The results from each subgroup, assessed at baseline and at regular follow-up periods, are reported since the project initiation. Inference testing was performed to look for statistically significant differences between goal attainments rates between sexes. At-goal rates for systolic blood pressure (SBP) were improved during the 33 months of the study, with females achieving higher goal rates when compared to males. On the other hand, at-goal control rates for total and low-density lipoprotein (LDL) cholesterol (chol) were better in males compared to females. Diabetic patients had lower at-goal rates for SBP and triglycerides but higher rates for LDL-chol. The LDL-chol at-goal rates were higher for males, while high-density lipoprotein (HDL)-chol rates were higher for females. Utilization of antihypertensive medications was similar during and after the baseline period for both men and women. Patients taking two or more antihypertensive medications had higher mean COSEHC™-11 scores compared to those on monotherapy. With treatment, hypertensive patients can reach SBP and cholesterol goals; however, population-wide improvement in treatment goal adherence continues to be a challenge for physicians. The COSEHC™ GVRM Study shows, however, that continuous monitoring and feedback to physicians of accurate longitudinal data is an effective tool in achieving better control rates of cardiovascular risk factors.
authors.affiliation: Department of Surgery, Internal Medicine-Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. cferrari@wakehealth.edu
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Ferrario
authors.forename: Janae
authors.initials: J
authors.lastname: Joyner
authors.forename: Chris
authors.initials: C
authors.lastname: Colby
authors.forename: Alex
authors.initials: A
authors.lastname: Exuzides
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.forename: Debra
authors.initials: D
authors.lastname: Simmons
authors.forename: William
authors.initials: W
authors.lastname: Bestermann
authors.forename: Feride
authors.initials: F
authors.lastname: Frech-Tamas
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D014280:Triglycerides
keywords: cardiovascular risk; coronary heart disease; dyslipidemia; electronic medical records; hypertension; metabolic syndrome
references.citation: N Engl J Med. 2011 Dec 15;365(24):2255-67
references.pmid: 22085343
references.citation: Ther Adv Cardiovasc Dis. 2009 Apr;3(2):157-74
references.pmid: 19299428
references.citation: Circulation. 2005 Aug 2;112(5):666-73
references.pmid: 16061755
references.citation: J Hypertens Suppl. 1998 Jan;16(1):S1-7
references.pmid: 9534090
references.citation: Ann Intern Med. 1997 May 15;126(10):761-7
references.pmid: 9148648
references.citation: Circulation. 2013 Jan 1;127(1):143-52
references.pmid: 23283859
references.citation: Lancet. 1999 Mar 6;353(9155):793-6
references.pmid: 10459960
references.citation: Am J Med Sci. 2004 May;327(5):234-5
references.pmid: 15166740
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: Vasc Health Risk Manag. 2010;6:1135-45
references.pmid: 21931496
references.citation: J Hypertens Suppl. 2009 Jul;27(5):S3-8
references.pmid: 19587552
references.citation: Curr Vasc Pharmacol. 2006 Jul;4(3):185-97
references.pmid: 16842136
references.citation: Nihon Rinsho. 2004 Mar;62 Suppl 3:605-11
references.pmid: 15179938
references.citation: N Engl J Med. 2008 Sep 18;359(12):1225-37
references.pmid: 18753639
references.citation: Circulation. 2004 Sep 14;110(11):1413-7
references.pmid: 15353497
references.citation: Can J Cardiol. 2001 Dec;17(12):1283-9
references.pmid: 11773939
references.citation: Am J Med Sci. 2005 Jun;329(6):292-305
references.pmid: 15958871
references.citation: Circulation. 2012 Dec 4;126(23):2705-12
references.pmid: 23212996
references.citation: Int J Cardiol. 2007 Apr 25;117(2):204-10
references.pmid: 16854482
references.citation: J Am Coll Cardiol. 2007 Jan 30;49(4):403-14
references.pmid: 17258085
references.citation: BMJ. 2001 Jul 14;323(7304):75-81
references.pmid: 11451781
references.citation: Endocr J. 2012;59(12):1065-76
references.pmid: 22971940
references.citation: J Hypertens. 2009 Apr;27(4):673-9
references.pmid: 19516168
references.citation: Arch Intern Med. 2000 May 22;160(10):1472-6
references.pmid: 10826460
references.citation: Therapie. 1995 Jul-Aug;50(4):353-62
references.pmid: 7482389
references.citation: J Am Soc Hypertens. 2010 Jan-Feb;4(1):32-41
references.pmid: 20374949
references.citation: Diabetes Care. 2000 Apr;23 Suppl 2:B65-71
references.pmid: 10860193
references.citation: Prev Med. 2009 Feb;48(2):115-6
references.pmid: 19124038
references.citation: Am Heart J. 2004 Jul;148(1):52-61
references.pmid: 15215792
references.citation: J Clin Hypertens (Greenwich). 2006 Oct;8(10):686-8
references.pmid: 17028480
references.citation: J Clin Hypertens (Greenwich). 2006 Dec;8(12):879-86
references.pmid: 17170614
references.citation: Am J Med Sci. 1999 Dec;318(6):357-64
references.pmid: 10616159
references.citation: J Hypertens. 2002 Aug;20(8):1461-4
references.pmid: 12172300
references.citation: Am J Med Sci. 2005 Jun;329(6):276-91
references.pmid: 15958870
references.citation: Am J Med Sci. 1997 Apr;313(4):195-209
references.pmid: 9099149
references.citation: Stroke. 1997 Dec;28(12):2557-62
references.pmid: 9412649
references.citation: Clin Biochem. 2013 Jan;46(1-2):5-9
references.pmid: 23063983
references.citation: JAMA. 2003 May 21;289(19):2560-72
references.pmid: 12748199
references.citation: Am J Med Sci. 2004 May;327(5):233
references.pmid: 15166739
references.citation: Blood Press Monit. 2000;5 Suppl 1:S9-S15
references.pmid: 10904237
references.citation: J Hypertens. 2009 May;27(5):923-34
references.pmid: 19381107
references.citation: J Am Coll Cardiol. 2012 Jun 5;59(23):2058-64
references.pmid: 22520249
references.citation: Cochrane Database Syst Rev. 2000;(3):CD002146
references.pmid: 10908526
references.citation: N Engl J Med. 2008 Apr 10;358(15):1547-59
references.pmid: 18378520
references.citation: Lancet. 2008 Sep 27;372(9644):1174-83
references.pmid: 18757085
references.citation: Arch Mal Coeur Vaiss. 1998 Aug;91(8):1059-63
references.pmid: 9749165
references.citation: Diabetes Care. 2007 Jul;30(7):1851-6
references.pmid: 17440172
references.citation: South Med J. 2004 Oct;97(10):932-8
references.pmid: 15558916
references.citation: Am J Med Sci. 1999 Dec;318(6):365-8
references.pmid: 10616160
references.citation: Am J Med Sci. 2006 Feb;331(2):59
references.pmid: 16479176
references.citation: Am Heart J. 2011 Mar;161(3):471-477.e2
references.pmid: 21392600