Treatment in a preventive cardiology clinic utilizing advanced practice providers effectively closes atherosclerotic cardiovascular disease risk‐management gaps among a primary‐prevention population compared with a propensity‐matched primary‐care cohort: A team‐based care model and its impact on lipid and blood pressure management. Issue 6 (5th June 2018)

• Record Type: Journal Article
• Authors: Fentanes, Emilio; Vande Hei, Anthony G.; Holuby, R. Scott; Suarez, Norma; Slim, Yousif; Slim, Jennifer N.; Slim, Ahmad M.; Thomas, Dustin
• Is Part Of: Clinical cardiology. Volume 41:Issue 6(2018)
• Page Start: 817
• Page End: 824
• Publication Date: 2018-06-05
• Subjects: Atherosclerosis -- Blood Pressure Control and Regulation -- Computed Tomography -- General Clinical Cardiology/Adult -- Imaging -- Preventive Cardiology; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22963
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract : Background: Advanced practice providers (APPs) can fill care gaps created by physician shortages and improve adherence/compliance with preventive ASCVD interventions. Hypothesis: APPs utilizing guideline‐based algorithms will more frequently escalate ASCVD risk factor therapies. Methods: We retrospectively reviewed data on 595 patients enrolled in a preventive cardiology clinic (PCC) utilizing APPs compared with a propensity‐matched cohort (PMC) of 595 patients enrolled in primary‐care clinics alone. PCC patients were risk‐stratified using Framingham Risk Score (FRS) and coronary artery calcium scoring (CACS). Results: Baseline demographics were balanced between the groups. CACS was more commonly obtained in PCC patients ( P < 0.001), resulting in reclassification of 30.6% patients to a higher risk category, including statin therapy in 26.6% of low‐FRS PCC patients with CACS ≥75th MESA percentile. Aspirin initiation was higher for high and intermediate FRS patients in the PCC ( P < 0.001). Post‐intervention mean LDL‐C, non–HDL‐C, and triglycerides (all P < 0.05) were lower in the PCC group. Compliance with appropriate lipid treatment was higher in intermediate to high FRS patients ( P = 0.004) in the PCC group. Aggressive LDL‐C and non–HDL‐C treatment goals (<70 mg/dL, P = 0.005 and < 130 mg/dL, P < 0.001, respectively), were more commonly achieved in high‐FRS PCC patients. Median post‐intervention SBP was lower among intermediate and low FRS patients ( P = 0.001 and P < 0.001, respectively). Cumulatively, this resulted in a reduction in median post‐intervention PCC FRS across all initial FRS risk categories ( P < 0.001 for all). Conclusions: APPs within a PCC effectively risk‐stratify and aggressively manage ASCVD risk factors, resulting in a reduction in post‐intervention FRS.