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The Impact of Concordant and Discordant Conditions on the Quality of Care for Hyperlipidemia

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Abstract

Background

Physician treatment of cardiovascular risk factors may be affected by specific types of patient comorbidities.

Objectives

To examine the relationship between discordant comorbidities and LDL-cholesterol management in hypertensive patients not previously treated with lipid-lowering therapy; to determine whether the presence of cardiovascular (concordant) conditions mediates this relationship.

Design

We performed a retrospective cohort study of 1,935 hypertensive primary care patients (men >45 years of age, women >55 years of age) with documented elevated low-density lipoprotein (LDL) cholesterol and no lipid-lowering therapy at baseline. The outcome was guideline-consistent hyperlipidemia management defined as optimal value on repeat LDL cholesterol testing or initiation of lipid-lowering therapy. Using generalized estimating equations (GEE), we examined the association of concordant and discordant comorbidities with guideline-consistent hyperlipidemia management over a 2-year follow-up period, adjusting for patient characteristics.

Results

Guideline-consistent hyperlipidemia management was achieved in 1,236 patients (64%). In the fully adjusted model, each additional discordant condition resulted in a 19% lower adjusted odds ratio of guideline-consistent hyperlipidemia management (p < 0.001) when compared with no discordant conditions. The dampening effect of discordant conditions on guideline-consistent management persisted even in the presence of concordant conditions, but each additional concordant condition was associated with a 37% increase in the adjusted odds of guideline-consistent hyperlipidemia management (p < 0.001).

Conclusions

In this cohort of hypertensive primary care patients, the number of conditions discordant with cardiovascular risk was strongly negatively associated with guideline-consistent hyperlipidemia management even in patients at the highest risk for cardiovascular events and cardiac death.

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Acknowledgements

Funding

Supported by Pfizer Inc. and the Robert Wood Johnson Foundation Clinical Scholars Program

Conflicts of Interest

Funding for this project was provided by an unrestricted grant from Pfizer Inc. The University of Pennsylvania provided the mechanism for administration of this grant. Investigators at the University of Pennsylvania and Pennsylvania State University performed the analyses. By contract, the investigators retain the right to publish results and manuscripts without approval from Pfizer Inc. Dr. Lagu is funded by The Robert Wood Johnson Foundation Clinical Scholars Program.

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Authors and Affiliations

  1. Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA

    Tara Lagu MD, MPH

  2. Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Mark G. Weiner MD, Susan Eachus PhD, J. Sanford Schwartz MD & Barbara J. Turner MD, MSEd

  3. Departments of Surgery and Health Evaluation Sciences, Penn State College of Medicine, Hershey, PA, USA

    Christopher S. Hollenbeak PhD

  4. US Outcomes Research, Pfizer Inc, New York, NY, USA

    Craig S. Roberts PharmD, MPA

  5. Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA

    Tara Lagu MD, MPH

Authors
  1. Tara Lagu MD, MPH
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  2. Mark G. Weiner MD
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  3. Christopher S. Hollenbeak PhD
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  4. Susan Eachus PhD
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  5. Craig S. Roberts PharmD, MPA
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  7. Barbara J. Turner MD, MSEd
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Correspondence to Tara Lagu MD, MPH.

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Lagu, T., Weiner, M.G., Hollenbeak, C.S. et al. The Impact of Concordant and Discordant Conditions on the Quality of Care for Hyperlipidemia. J GEN INTERN MED 23, 1208–1213 (2008). https://doi.org/10.1007/s11606-008-0647-4

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  • DOI: https://doi.org/10.1007/s11606-008-0647-4

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