Abstract 060: Association of Body Mass Index With Risk Factor Optimization and Guideline Directed Medical Therapy in Veterans With Cardiovascular Disease
Notice bibliographique
Résumé
Background: Obesity is an epidemic in the United States and has been linked to the development of cardiovascular diseases (CVD) including atherosclerosis, heart failure and hypertension. However, obesity has been associated with better survival once CVD is established and has been referred to as the “obesity paradox”. Medical management and risk factor optimization are recommended for patients with all forms of CVD. The association of body mass index (BMI) with performance measure compliance is not known. Methods: In a large national cohort, we identified 1,242,015 patients with CVD receiving care in 130 Veterans Affairs facilities between 10/1/2013 and 9/30/2014. CVD was defined as the presence of ischemic heart disease, peripheral artery disease, or ischemic cerebrovascular disease. We assessed the frequency of compliance with performance measures in patients divided into 5 groups: underweight (BMI <18.5 Kg/m 2 ), normal BMI (18.5-24.9 Kg/m 2 ), overweight (25-29.9 Kg/m 2 ), obese (30-39.9 Kg/m 2 ), and extremely obese (>=40 Kg/m 2 ). We compared compliance with hypertension control (BP <140/90 mmHg), diabetes control (HbA1C <=9% among diabetics), use of statin, and use of antiplatelet therapy among the 5 groups. A composite of all 4 measures (BP control, statin use, antiplatelet use, HbA1C <=9% among diabetics) termed optimal medical therapy (OMT) was also compared among the groups. Multivariable logistic regression was performed with normal BMI as the referent category. Results (Table): Underweight comprised 12,623 (1.1%), normal BMI 230,471 (20.5%), overweight 413,590 (36.8%), obese 404,105 (36%), and extremely obese 61,778 (5.5%). Compliance with risk factor control (hypertension and diabetes control) was higher in the underweight and normal BMI group and lowest in the extremely obese group. However, statin and antiplatelet use was lowest in the underweight group and highest in the obese and extremely obese groups. Overall, only 32.7%-45.5% received OMT (i.e. met the composite measure) and was highest in the overweight group. Conclusions: Compliance with OMT was low in all patients. Patients that were underweight and extremely obese were least likely to receive OMT. Our results suggest potential for improvement in OMT for all CVD patients especially those that are underweight and extremely obese.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».