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J Natl Med Assoc. 2008 Nov;100(11):1260-70.

Treating patients with multiple cardiovascular conditions: an analysis of outpatient data in the United States, 2005.

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Georgetown University School of Medicine, Washington, DC, USA.



Few studies have examined treatment rates in patients with multiple cardiovascular risk factors. This study assessed outpatient visit and treatment patterns among patients having > or =1 cardiovascular conditions.


Nationally representative outpatient survey data were used to identify patients > or =25 years with hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease or congestive heart failure during the year 2005 (n=15,060 records). Prevalence and visit patterns were examined for each cardiovascular condition by race/ethnicity, sex and age. Adherence to recommended treatment was also assessed using logistic regression.


Prevalence rates generally increased with age, and several subgroup patterns were observed for some cardiovascular conditions. Visit rates were similar, with most patients seeing their providers about 3-4 times during the year. Hypertension, the most prevalent condition, had the highest treatment rate (88%) versus ischemic heart disease, one of the least prevalent conditions, which had the lowest treatment rate (28%). Treatment rates decreased with increasing numbers of cardiovascular conditions. Appropriate treatment was independently associated with decreasing numbers of cardiovascular conditions, treatment by the primary care provider and treatment with a combination agent-but not race/ethnicity, sex or primary payment source.


While patients with multiple cardiovascular conditions visit their providers several times during the year, they are still largely undertreated, particularly as their cardiovascular disease burden increases. These findings may suggest that patients with multiple cardiovascular conditions are getting lower-quality care because of the greater demands placed on their physicians. Adherence to treatment guidelines may improve with adoption of a polypill and by encouraging patients to have a primary care home.

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