CVD Outcomes Aggregate Report Report Period: 05/01/ /30/2004
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1 Changes in JNC VII Blood Pressure Categories Blood Pressure Category Initial Value ¹ Latest Value ¹ Improvement ² (Based on JNC VII Guidelines) values (days) (N=271) (N = 209) Normal (SBP < 120 and DBP < 80) 62 ( 23%) 106 ( 39%) (49%) Prehypertension (SBP or DBP 0-89) 129 ( 48%) 117 ( 43%) Stage 1 (SBP or DBP 90-99) 65 ( 24%) 40 ( 15%) Stage 2 (SBP >/= 160 or DBP >/= 100) 15 ( 6%) 8 ( 3%) ¹Blood pressure values included in this table are from all data sources. ²Improvement is defined as patients with an initial value in the Prehypertension, Stage 1, or Stage 2 category who improved at least one category with their latest value. (i.e. moved from Stage 2 to Stage 1). Changes in LDL Cholesterol Levels LDL Category Initial Value ¹ Latest Value ¹ Improvement ² (Based on ATP III Guidelines) values (days) (N=36) Less than ( 50%) 24 ( 67%) ( 28%) 6 ( 17%) ( 11%) 4 ( 11%) ( 8%) 2 ( 6%) Greater than or equal to ( 3%) 0 ( 0%) (N=21) ³ (N=11) At LDL Goal¹¹ 10 ( 48%) 14 ( 67%) 4 (36%) Not at LDL Goal¹¹ 11 ( 52%) 7 ( 33%) ¹LDL Values included in this table are from all data sources. ²Improvement is defined as those patients who were not at goal with the initial value but met their goal with the latest value. ³Patients included are those with at least two LDL values recorded during the reporting period who also had an LDL goal in place at the time each LDL value was collected. Page 1 of 6
2 ¹¹LDL Goals are set by the Care Manager based on the ATP III guidelines or Care Manger discretion. Changes in ACC/AHA Heart Failure Treatment Classes ACC/AHA Heart Failure Treatment Class (N=356) Initial Value Latest Value Stage A 0 ( 0%) 0 ( 0%) Stage B 15 ( 4%) 10 ( 3%) Stage C 341 ( 96%) 346 ( 97%) Stage D 0 ( 0%) 0 ( 0%) Diastolic dysfunction 0 ( 0%) 0 ( 0%) Changes in New York Heart Association (NYHA) Classes Among Patients with Heart Failure Heart Failure patients with NYHA classifications (N=287) Initial Value Latest Value values (days) Improvement ¹ (N=167) Class I 120 ( 42%) 149 ( 52%) (62 %) Class II 87 ( 30%) 98 ( 34%) Class III 43 ( 15%) 27 ( 9%) Class IV 37 ( 13%) 13 ( 5%) ¹Improvement is defined as those patients who were initially in Class II, III, or IV and improved at least one class with the latest value (i.e. moved from Class II to Class I). Changes in Daily Weight Monitoring Among Patients with Heart Failure Heart Failure Patients with Questionnaire Initial Value Latest Value Improvement ¹ Responses to Weight Monitoring values (days) (N=3) (N=1) Daily² 2 ( 67%) 2 ( 67%) (0 %) Page 2 of 6
3 Changes in Daily Weight Monitoring Among Patients with Heart Failure (Continued) Heart Failure Patients with Questionnaire Initial Value Latest Value Improvement ¹ Responses to Weight Monitoring values (days) ¹Improvement is defined as those patients who were not monitoring weight daily at the initial value and were monitoring weight daily with the latest value. ²Daily weight monitoring is determined by the patients's response of "Daily" to a specific question within a CVD questionnaire that asks "How often do you currently weigh yourself to monitor your heart failure signs and symptoms at home?" Medication Use Among Patients in Symptomatic ACC/AHA Heart Failure Treatment Classes Medication Type Continuous Use¹ Delayed start, then Used, then discontinued³ Intermittent Use¹¹ No Use²¹ continuous use² ACC/AHA Class: Stage C & D (N=346) ¹² ACE inhibitors 223 ( 64%) 7 ( 2%) 24 (7 %) 0 (0%) 82 (24 %) ARBs¹³ 19 ( 5%) 9 ( 3%) 3 (1 %) 0 (0%) 113 (33 %) Beta-blockers 191 ( 55%) 9 ( 3%) 12 (3 %) 4 (1%) 121 (35 %) Diuretics 293 ( 85%) 6 ( 2%) 5 (1 %) 2 (1%) 36 (10 %) Digoxin 95 ( 27%) 2 ( 1%) 7 (2 %) 0 (0%) 235 (68 %) ACC/AHA Class: Diastolic Dysfunction (N=0) Diuretics 0 ( 0%) 0 ( 0%) 0 (0 %) 0 (0%) 0 (0 %) ¹Includes patients who were on the medication for the entire report period -or- were given the ACC/AHA classification during the report period and started the medication within 30 days of the classification and continued taking it until the end of the report period. ²Includes patients who were given the ACC/AHA classification prior/during the report period and started the medication more than 30 days after the classification occurred and continued taking it until the end of the report period. ³Includes patients who were on the medication at some time during the report period but discontinued use for the remainder of the report period. ¹¹Includes patients who were on the medication two or more times during the report period but had discontinued use in between the times it was being taken. ¹²The sum of the percentages for patients within a column may exceed 100% because the patients could have been on multiple medications. Page 3 of 6
4 ¹³The values for ARBs have the potential for being understated as the data is only collected within the Clinical Data module and is not currently collected via questionnaires like the other medications in this section. ²¹Includes patients that had only a "No" value entered for the medication category for the report period. Changes in Canadian Cardiovascular Society (CCS) Angina Classes CCS Class Initial Value Latest Value values (days) Improvement ¹ (N=1) ² (N=1) No Angina ( 100%) (100 %) Class I 0 ( 0%) 0 ( 0%) Class II 0 ( 0%) 0 ( 0%) Class III 1 ( 100%) 0 ( 0%) Class IV 0 ( 0%) 0 ( 0%) ¹Improvement is defined as those patients who were initially in Class I, II, III or IV and improved at least one class or moved to No Angina with the latest value (i.e. moved from Class IV to Class III or moved from Class I to No Angina). ²Patients with No Angina for the latest value will be included in this table if the initial value was Class I, Class II, Class III, or Class IV. Medication Use Among Patients with a Prior Myocardial Infarction Medication Type Continuous Use¹ Delayed start, then Used, then discontinued³ Intermittent Use¹¹ No Use²¹ continuous use² Patients with prior MI (N=199) ¹² ACE inhibitors 83 ( 42%) 51 ( 26%) 14 (7 %) 0 (0 %) 46 (23 %) ARBs¹³ 9 ( 5%) 9 ( 5%) 1 (1 %) 0 (0 %) 62 (31 %) Beta-blockers 77 ( 39%) 54 ( 27%) 8 (4 %) 2 (1 %) 55 (28 %) Antiplatelet/Anticoagulation (includes Aspirin, Clopidogrel, and Warfarin) 95 ( 48%) 65 ( 33%) 0 (0 %) 1 (1 %) 9 (5 %) Page 4 of 6
5 ¹Includes patients who were on the medication for the entire report period -or- had an MI reported during the report period and started the medication within 30 days of the reported MI and continued taking it until the end of the report period. ²Includes patients who had an MI reported prior/during the report period and started the medication more than 30 days after the MI was reported and continued taking it until the end of the report period. ³Includes patients who were on the medication at some time during the report period but discontinued use for the remainder of the report period. ¹¹Includes patients who were on the medication two or more times during the report period but had discontinued use in between the times it was being taken. ¹²The sum of the percentages for patients within a column may exceed 100% because the patients could have been on multiple medications. ¹³The values for ARBs have the potential for being understated as the data is only collected within the Clinical Data module and is not currently collected via questionnaires like the other medications in this section. ²¹Includes patients that had only a "No" value entered for the medication category for the report period. AntiPlatelet/AntiCoagulant Use Among Patients with Atrial Fibrillation Medication Type Continuous Use¹ Delayed start, then Used, then discontinued³ Intermittent Use¹¹ continuous use² Patients with Atrial Fibrillation (N=162) ¹² Aspirin 83 ( 51%) 7 ( 4%) 6 (4 %) 1 (1 %) Clopidogrel 13 ( 8%) 0 ( 0%) 1 (1 %) 0 (0 %) Warfarin 66 ( 41%) 8 ( 5%) 4 (2 %) 0 (0 %) No use of aspirin, clopidogrel, or warfarin: 10 ( 6%) ¹Includes patients who were on the medication for the entire report period -or- had a diagnosis of atrial fibrillation during the report period and started the medication within 30 days of the diagnosis and continued taking it until the end of the report period. ²Includes patients who had a diagnosis of atrial fibrillation prior/during the report period and started the medication more than 30 days after the diagnosis was reported and continued taking it until the end of the report period. ³Includes patients who were on the medication at some time during the report period but discontinued use for the remainder of the report period. ¹¹Includes patients who were on the medication two or more times during the report period but had discontinued use in between the times it was being taken. ¹²The sum of percentages for patients within a column may exceed 100% because the patients could have been on multiple medications. Page 5 of 6
6 Changes in INR Goal Achievement INR /Goal Initial Value Latest Value Relationship values (days) (N=21) ¹ INR within goal range 7 ( 33%) 8 ( 38%) 311 INR above goal range 12 ( 57%) 12 ( 57%) INR below goal range 2 ( 10%) 1 ( 5%) ¹Patients included are those with at least two INR values recorded during the reporting period who also had a goal in place at the time each INR value was collected. Changes in Mean SF-12 Scores Among Patients in the CVD Program and Patients with Heart Failure SF-12 Questionnaire Component Initial Value Latest Value Mean Score (SD) Mean Score (SD) values (days) Patients in CVD Program (N=249) Mental Health Score 54.4 (8.11 ) 55.1 (7.70 ) 353 Physical Health Score 36.9 (10.83 ) 36.8 (10.73 ) Patients with Heart Failure (N=197) Mental Health Score 54.9 (7.67 ) 55.7 (7.23 ) 398 Physical Health Score 37.7 (10.94 ) 37.4 (10.79 ) Page 6 of 6
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