Background: Cardiovascular disease (CVD) is a systemic process with patients developing atherosclerosis in multiple vascular beds including ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD) and peripheral artery disease (PAD). PAD and ICVD are associated with increased risk of subsequent myocardial infarction, stroke and death. Medical management and risk factor optimization are recommended for all patients with CVD. Compliance with measures in patients with ICVD and PAD compared to IHD is not known.
Methods: In a large national cohort, we identified 1,242,015 patients with cardiovascular disease (CVD) receiving care in 130 Veterans Affairs facilities between 10/1/2013 and 9/30/2014. CVD was defined as the presence of IHD, PAD, or ICVD. We assessed the frequency of compliance with performance measures in patients with IHD (with or without concomitant PAD or ICVD), PAD only, ICVD only, and PAD+ICVD groups. We compared compliance with hypertension control (BP <140/90 mmHg), diabetes control (HbA1C<7.0% among diabetics), and the use of statin therapy between IHD and PAD, ICVD, or PAD+ICVD groups. A composite of all 3 measures (BP control, statin use, HbA1C <7% among diabetics) termed optimal medical therapy (OMT) was also compared between groups. Multivariate logistic regression was performed with IHD group as the referent category.
Results (Table): IHD patients comprised 989,380 (79.7%), PAD only 70,404 (5.7%), ICVD only 163,730 (13.2%) and PAD + ICVD 18,501 (1.5%) of the cohort. Compliance with most measures (hypertension control, statin use) as well as OMT was lower for PAD or ICVD patients compared with IHD patients with minimal differences between IHD and PAD +CVD group. Overall, only 32.3%-41.8% received OMT (i.e. met the composite measure).
Conclusions: Compliance with OMT was low in all patients. Patients with PAD or ICVD were less likely to receive OMT compared with IHD. Our results suggest potential for improvement in OMT for all CVD patients especially those with PAD and ICVD.