The COSEHC™ Global Vascular Risk Management quality improvement program: first follow-up report

Abstract

Carlos M Ferrario,1 JaNae Joyner,2 Chris Colby,3 Alex Exuzides,3 Michael Moore,2,6 Debra Simmons,2 William Bestermann Jr,4 Feride Frech-Tamas51Department of Surgery, Internal Medicine–Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 2Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA; 3ICON Late Phase and Outcomes Research, San Francisco, CA, USA; 4Vascular Medicine Center, Holston Medical Group, Kingsport, TN, USA; 5Department of Health Economics, Daiichi Sankyo, Inc, Parsippany, NJ, USA; 6Danville Regional Medical Center, Danville, VA, USAAbstract: 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.Keywords: cardiovascular risk, coronary heart disease, dyslipidemia, electronic medical records, hypertension, metabolic syndrome