Abstract P324: Implications of ACC/AHA Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus among Several U.S. Networks of Community Health Centers

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Ehimare Akhabue ◽  
Sarah S Rittner ◽  
Joseph E Carroll ◽  
Philip M Crawford ◽  
Lydia Dant ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Community Health ◽  
Community Health Centers ◽  
Heart Association ◽  
Female Gender ◽  
Statin Treatment ◽  
Health Centers ◽  
Research Network ◽  
High Risk Population ◽  
Care Gaps

Introduction: Little is known about statin underuse among diabetes (DM) patients cared for in community health centers (CHCs), which tend to serve socioeconomically disadvantaged populations. Implications of the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear. Hypothesis: Substantial statin underutilization will exist regardless of differences between guidelines. Methods: We included 32,440 adults (45% male, 63% non-white, 28% uninsured/Medicaid) with DM aged 40 to 75 years who received care within 16 CHC groups in eleven states in the Community Health Applied Research Network (CHARN) during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel (ATPIII) 2001 guideline and ACC/AHA 2013 guideline. Results: More patients were concordant with the ACC/AHA (52.8%) versus ATPIII (36.2%) guideline. Female gender was independently associated with lower concordance for both guidelines [OR 0.90 CI (0.85-0.94) and OR 0.84 CI (0.80-0.88) respectively]. Black race was associated with lower concordance with ATPIII but not ACC/AHA. Being insured, Asian/Pacific Islander or primarily Spanish speaking were associated with greater concordance for both guidelines. 35% (11526/32440) of the cohort were concordant with neither guideline (Figure), the majority (80%) having no statin prescribed. 28% (9168/32440) were concordant with ACC/AHA guidelines but not ATPIII guidelines. 8.5% of these patients had an LDL >160 despite having a medium or high intensity statin prescribed. 12% (3772/32440) were concordant with ATPIII but not ACC/AHA guidelines. Most of these patients had an LDL between 70-99 mg/dl with no or a low intensity statin prescribed. Conclusions: Opportunities exist to improve cholesterol management in DM patients in CHCs. Addressing care gaps could improve cardiovascular disease prevention in this high risk population.

scholarly journals Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers

2017 ◽  
Vol 133 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Kenneth H. Mayer ◽  
Stephanie Loo ◽  
Phillip M. Crawford ◽  
Heidi M. Crane ◽  
Michael Leo ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Community Health ◽  
Community Health Centers ◽  
Primary Care Providers ◽  
Health Centers ◽  
Research Network ◽  
People Living With Hiv ◽  
Care Providers

Objectives: As the life expectancy of people infected with human immunodeficiency virus (HIV) infection has increased, the spectrum of illness has evolved. We evaluated whether people living with HIV accessing primary care in US community health centers had higher morbidity compared with HIV-uninfected patients receiving care at the same sites. Methods: We compared data from electronic health records for 12 837 HIV-infected and 227 012 HIV-uninfected patients to evaluate the relative prevalence of diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, and malignancies by HIV serostatus. We used multivariable logistic regression to evaluate differences. Participants were patients aged ≥18 who were followed for ≥3 years (from January 2006 to December 2016) in 1 of 17 community health centers belonging to the Community Health Applied Research Network. Results: Nearly two-thirds of HIV-infected and HIV-uninfected patients lived in poverty. Compared with HIV-uninfected patients, HIV-infected patients were significantly more likely to be diagnosed and/or treated for diabetes (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.22-1.41), hypertension (OR = 1.38; 95% CI, 1.31-1.46), dyslipidemia (OR = 2.30; 95% CI, 2.17-2.43), chronic kidney disease (OR = 4.75; 95% CI, 4.23-5.34), lymphomas (OR = 4.02; 95% CI, 2.86-5.67), cancers related to human papillomavirus (OR = 5.05; 95% CI, 3.77-6.78), or other cancers (OR = 1.25; 95% CI, 1.10-1.42). The prevalence of stroke was higher among HIV-infected patients (OR = 1.32; 95% CI, 1.06-1.63) than among HIV-uninfected patients, but the prevalence of myocardial infarction or coronary artery disease did not differ between the 2 groups. Conclusions: As HIV-infected patients live longer, the increasing burden of noncommunicable diseases may complicate their clinical management, requiring primary care providers to be trained in chronic disease management for this population.

scholarly journals A Practice-Based Research Network (PBRN) Roadmap for Evaluating COVID-19 in Community Health Centers: A Report From the OCHIN PBRN

2020 ◽  
Vol 33 (5) ◽  
pp. 774-778
Author(s):  
Jennifer E. DeVoe ◽  
Sonja M. Likumahuwa-Ackman ◽  
Heather E. Angier ◽  
Nathalie Huguet ◽  
Deborah J. Cohen ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Centers ◽  
Health Centers ◽  
Research Network ◽  
Practice Based Research

scholarly journals Neck circumference and waist circumference associated with cardiovascular events in type 2 diabetes (Beijing Community Diabetes Study 23)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guang-Ran Yang ◽  
Ming-Xia Yuan ◽  
Gang Wan ◽  
Xue-Lian Zhang ◽  
Han-Jing Fu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Waist Circumference ◽  
Community Health ◽  
Cardiovascular Events ◽  
Community Health Centers ◽  
Neck Circumference ◽  
Health Centers ◽  
Diabetes Patients

AbstractObesity increases the risk of developing cardiovascular disease and other metabolic diseases. We intended to compare three different anthropometric indicators of obesity, in predicting the incidence of cardiovascular events in Chinese type 2 diabetes. Beijing Community Diabetes Study was a prospective multi-center study conducted in Beijing community health centers. Type 2 diabetes patients from fourteen community health centers were enrolled at baseline. The primary endpoint was cardiovascular events. The upper quartile of neck circumference (NC) was set as greater NC. A total of 3299 diabetes patients were enrolled. In which, 941 (28.52%) had cardiovascular disease at baseline. Logistic analysis showed that central obesity (waist circumference (WC) above 90 cm in men and 85 cm in women) and greater NC were all related to baseline cardiovascular disease (adjusted OR = 1.49, and 1.55). After 10-year follow-up, 340 (10.31%) had cardiovascular events. Compared with patients without cardiovascular events, those having cardiovascular events had higher BMI, larger WC and NC. Cox regression analysis showed that greater WC and NC were all associated with the occurrence of cardiovascular events (adjusted HR = 1.41, and 1.38). A higher NC and WC might increase the risk of cardiovascular events by about 40% in type 2 diabetes patients in Beijing communities.

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