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      Clinical Inertia in the Management of Low‐Density Lipoprotein Abnormalities in an HIV Clinic

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          Abstract

          A retrospective cohort study evaluating the frequency of and factors related to clinical inertia in low-density lipoprotein (LDL) management was performed. Subjects were 90 patients that were not meeting National Cholesterol Education Program Adult Treatment Panel III LDL goals at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic between 1 August 2004 and 1 August 2005. Clinical inertia was observed in 44% of cases. Patients with higher baseline LDL levels were less likely to experience inertia, whereas women and those in the highest coronary heart disease risk category were more likely to be affected.

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          Cardiovascular risk and body-fat abnormalities in HIV-infected adults.

          Steven Grinspoon, Andrew W. Carr (2005)
          Article 0 comments Cited 200 times – based on 0 reviews     Review now
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            Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus.

            D Bauer, Simon FT Tang, Joe V Selby … (2006)
            Poorly controlled cardiovascular risk factors are common. Evaluating whether physicians respond appropriately to poor risk factor control in patients may better reflect quality of care than measuring proportions of patients whose conditions are controlled. To evaluate therapy modifications in response to poor control of hypertension, dyslipidemia, or diabetes in a large clinical population. Retrospective cohort study within an 18-month period in 2002 to 2003. Kaiser Permanente of Northern California. 253,238 adult members with poor control of 1 or more of these conditions. The authors assessed the proportion of patients with poor control who experienced a change in pharmacotherapy within 6 months, and they defined "appropriate care" as a therapy modification or return to control without therapy modification within 6 months. A total of 64% of patients experienced modifications in therapy for poorly controlled systolic blood pressure, 71% for poorly controlled diastolic blood pressure, 56% for poorly controlled low-density lipoprotein cholesterol level, and 66% for poorly controlled hemoglobin A1c level. Most frequent modifications were increases in number of drug classes (from 70% to 84%) and increased dosage (from 15% to 40%). An additional 7% to 11% of those with poorly controlled blood pressure, but only 3% to 4% of those with elevated low-density lipoprotein cholesterol level or hemoglobin A1c level, returned to control without therapy modification. Patients with more than 1 of the 3 conditions, higher baseline values, and target organ damage were more likely to receive "appropriate care." Patient preferences and suboptimal adherence to therapy were not measured and may explain some failures to act. As an additional measure of the quality of care, measuring therapy modifications in response to poor control in a large population is feasible. Many patients with poorly controlled hypertension, dyslipidemia, or diabetes had their therapy modified and, thus, seemed to receive clinically "appropriate care" with this new quality measure.
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              Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort Study.

              Pietro Vernazza, Enrique H Bucher, R Weber … (2006)
              Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10-year risk of CHD in a large cohort of HIV-infected individuals. All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut-offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. Overall, 8,033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high-density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10-20%) 10-year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART-naive patients. During the 6-year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol.
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                Author and article information

                Journal
                Title: Clinical Infectious Diseases
                Abbreviated Title: CLIN INFECT DIS
                Publisher: University of Chicago Press
                ISSN (Print): 1058-4838
                ISSN (Electronic): 1537-6591
                Publication date Created: April 15 2008
                Publication date (Print): April 15 2008
                Volume: 46
                Issue: 8
                Pages: 1315-1318
                Article
                DOI: 10.1086/533466
                PubMed ID: 18444873
                SO-VID: 87973100-120d-43e1-96cc-7d69cf1273f1
                Copyright © © 2008
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