Open AccessTreatment 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
Author(s) -
Fentanes Emilio,
Vande Hei Anthony G.,
Holuby R. Scott,
Suarez Norma,
Slim Yousif,
Slim Jennifer N.,
Slim Ahmad M.,
Thomas Dustin
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22963
Subject(s) - medicine , cohort , statin , propensity score matching , framingham risk score , population , risk factor , atherosclerotic cardiovascular disease , coronary artery disease , psychological intervention , aspirin , pharmacist , retrospective cohort study , guideline , primary care physician , primary care , cardiology , disease , family medicine , pharmacy , pathology , environmental health , psychiatry
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.