TY - JOUR
T1 - Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease
T2 - A Nationwide Population-Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes
AU - Abdel-Rahman, Nura
AU - Calderon-Margalit, Ronit
AU - Cohen, Arnon
AU - Elran, Einat
AU - Cohen, Avivit Golan
AU - Krieger, Michal
AU - Paltiel, Ora
AU - Valinsky, Liora
AU - Ben-Yehuda, Arie
AU - Manor, Orly
N1 - Publisher Copyright:
© 2022 The Authors.
PY - 2022/10/4
Y1 - 2022/10/4
N2 - BACKGROUND: Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. METHODS AND RESULTS: We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006–2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011–2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose–response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49– 1.72) and 1.23 (95% CI, 1.14–1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50–1.69) for cardiac outcomes. CONCLUSIONS: Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
AB - BACKGROUND: Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. METHODS AND RESULTS: We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006–2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011–2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose–response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49– 1.72) and 1.23 (95% CI, 1.14–1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50–1.69) for cardiac outcomes. CONCLUSIONS: Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
KW - diabetes
KW - heart failure
KW - ischemic heart disease
KW - longitudinal adherence
KW - national cohort
KW - quality indicators
KW - quality of diabetes care
UR - http://www.scopus.com/inward/record.url?scp=85139404527&partnerID=8YFLogxK
U2 - 10.1161/JAHA.122.025603
DO - 10.1161/JAHA.122.025603
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C2 - 36129044
AN - SCOPUS:85139404527
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 19
M1 - e025603
ER -
