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

Abstract

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.

Figure 1

Attainment of at-goal rates at the completion of the 33 months for subjects who were at-goal versus not at-goal for the measured cardiovascular risk factors. Abbreviations: SBP, systolic blood pressure; LDL, low-density lipoprotein; HDL, high-density lipoprotein; T, total.

Figure 2

Sex differences in COSEHC™ risk scores. Notes: Although sex has a direct influence on the Consortium for Southeastern Hypertension Control™ (COSEHC) risk factor scoring, the data show a significant increase in the risk for females who are not at-goal at the end of the examined period. Values are means ± standard deviation of the risk score for males and females with one (A) or two or more (B) medications. Statistical differences are denoted in the graph. All other comparisons were not statistically significant (P > 0.05).

Figure 3

Clinical events documented during the 33 months for the overall patient population. Notes: Data are from events recorded by physicians using International Classification of Disease, 9th revision (ICD-9) codes starting with 410 (see Methods). Stroke includes both hemorrhagic and ischemic stroke. Abbreviation: ACS, acute coronary syndrome; TIA, transient ischemic attack; CHF, congestive heart failure; CVD, other cardiovascular events.