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. 2008 Aug;23(8):1208-13.
doi: 10.1007/s11606-008-0647-4. Epub 2008 May 9.

The impact of concordant and discordant conditions on the quality of care for hyperlipidemia

Tara Lagu  1 , Mark G Weiner, Christopher S Hollenbeak, Susan Eachus, Craig S Roberts, J Sanford Schwartz, Barbara J Turner
Affiliations

The impact of concordant and discordant conditions on the quality of care for hyperlipidemia

Tara Lagu et al. J Gen Intern Med. 2008 Aug.

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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Figures

Figure 1
Figure 1
Appropriate management of elevated LDL cholesterol over 2-year follow-up. Number of discordant comorbidities vs. adjusted odds of management. Reference group is no discordant comorbidities. Model adjusted for race, sex, age, income (based on census tract), insurance type, number of visits, number of antihypertensive medications, presence of heart failure, presence of valvular disease, and number of concordant conditions.
Figure 2
Figure 2
Appropriate management of elevated LDL cholesterol over 2-year follow-up. Number of concordant comorbidities vs. adjusted odds of management. Reference group is no concordant comorbidities. Model adjusted for race, sex, age, income (based on census tract), insurance type, number of visits, number of antihypertensive medications, presence of heart failure, presence of valvular disease, and number of discordant conditions.
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