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Comparative Study

Provider compliance with guidelines for management of cardiovascular risk in HIV-infected patients

Kenneth A Lichtenstein et al. Prev Chronic Dis. 2013.

Abstract

Introduction: Compliance with National Cholesterol Education Program Adult Treatment Panel III (NCEP) guidelines has been shown to significantly reduce incident cardiovascular events. We investigated physicians' compliance with NCEP guidelines to reduce cardiovascular disease (CVD) risk in a population infected with HIV.

Methods: We analyzed HIV Outpatient Study (HOPS) data, following eligible patients from January 1, 2002, or first HOPS visit thereafter to calculate 10-year cardiovascular risk (10yCVR), until September 30, 2009, death, or last office visit. We categorized participants into four 10yCVR strata, according to guidelines determined by NCEP, the Infectious Disease Society of America, and the Adult AIDS Clinical Trials Group. We calculated percentages of patients treated for dyslipidemia and hypertension, calculated percentages of patients who achieved recommended goals, and categorized them by 10yCVR stratum.

Results: Of 2,005 patients analyzed, 33.7% had fewer than 2 CVD risk factors. For patients who had 2 or more risk factors, 10yCVR was less than 10% for 28.2%, 10% to 20% for 18.2%, and higher than 20% for 20.0% of patients. Of patients eligible for treatment, 81% to 87% were treated for elevated low-density lipoprotein cholesterol/non-high-density lipoprotein cholesterol (LDL-C/non-HDL-C), 2% to 11% were treated for low HDL-C, 56% to 91% were treated for high triglycerides, and 46% to 69% were treated for hypertension. Patients in higher 10yCVR categories were less likely to meet treatment goals than patients in lower 10yCVR categories.

Conclusion: At least one-fifth of contemporary HOPS patients have a 10yCVR higher than 20%, yet a large percentage of at-risk patients who were eligible for pharmacologic treatment did not receive recommended interventions and did not reach recommended treatment goals. Opportunities exist for CVD prevention in the HIV-infected population.

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Figures

Figure 1
Figure 1
Percentage of patients with condition treated per National Cholesterol Education Program Adult Treatment Panel III (NCEP) guidelines, by sex, the HIV Outpatient Study, January 2002–September 2009. Error bars indicate 95% confidence intervals. Abbreviations: LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. [Table: see text]
Figure 2
Figure 2
Percentage of patients with condition treated per National Cholesterol Education Program Adult Treatment Panel III (NCEP) Guidelines, by race/ethnicity, the HIV Outpatient Study, January 2002–September 2009. Error bars represent 95% confidence intervals. Abbreviations: LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. [Table: see text]
Figure 3
Figure 3
Percentage of patients with condition treated per National Cholesterol Education Program Adult Treatment Panel III (NCEP) Guidelines, by payer, the HIV Outpatient Study, January 2002–September 2009. Error bars represent 95% confidence intervals. Abbreviations: LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. [Table: see text]
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