Study Assesses Cardiovascular Risk Reduction Clinic for Veterans with Diabetes
The Cardiovascular Risk Reduction Clinic (CRRC) is a pharmacist-coordinated clinic at the Providence VAMC designed to treat the four traditional cardiovascular risk factors (diabetes, dyslipidemia, hypertension, and smoking) to attain goals set forth by the national guidelines for patients with diabetes or documented cardiovascular disease. Veterans are discharged from the CRRC when guideline-recommended goals for hemoglobin A1c (HbA1c <7%), low-density lipoprotein cholesterol (LDL-C <100 mg/dL), blood pressure (<130/80 mm Hg), and smoking are achieved or mostly achieved. This study evaluated the maintenance of these goals for two to three years after discharge from the CRRC. Investigators retrospectively reviewed VA electronic medical record data for 231 Veterans who were enrolled in the program between 10/01 and 9/03. To identify potential determinants of failure to maintain attained goals, investigators analyzed information on key demographics (e.g., gender, ethnicity) and clinical characteristics (e.g., history of heart failure, body mass index) obtained upon entry into the CRRC program.
Findings show that Veterans who completed the program maintained two goals – HbA1c and LDL-C – over three years of observation. The effect on blood pressure was less durable, with half of the Veterans who were at target levels at discharge from the CRRC reaching systolic BP >130 within six months after discharge. Results also show that the most important factor to consider for risk of failure after successful attainment of a cardiovascular goal is how poorly controlled the goal was at baseline. Thus, more sustained attention or booster interventions for those with worse control at entry into the program may be necessary.
Pirraglia P, Taveira T, Cohen L, Dooley A, and Wu W. Maintenance of cardiovascular risk goals in veterans with diabetes after discharge from a cardiovascular risk reduction clinic. Preventive Cardiology Winter 2009;12(1):3-8.
The study was funded by HSR&D. Dr. Pirraglia is supported by an HSR&D Career Development Award. All authors are part of HSR&D’s Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation in Providence, RI.