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Schmittdiel JA, Dyer W, Uratsu C, Magid DJ, O'Connor PJ, Beck A, Butler M, Ho MP, Vazquez-Benitez G, Adams AS. Initial persistence with antihypertensive therapies is associated with depression treatment persistence, but not depression. J Clin Hypertens (Greenwich) 2014; 16:412-7. [PMID: 24716533 PMCID: PMC4061252 DOI: 10.1111/jch.12300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the relationship between the presence of clinical depression and persistence to drug therapy treatment for depression with early nonpersistence to antihypertensive therapies in a large, diverse cohort of newly treated hypertension patients. Using a hypertension registry at Kaiser Permanente Northern California, the authors conducted a retrospective cohort study of 44,167 adults (18 years and older) with hypertension who were new users of antihypertensive therapy in 2008. We used multivariate logistic regression analysis to model the relationships between the presence of clinical depression and early nonpersistence (defined as failing to refill the first prescription within 90 days after the end of the first fill days' supply) to antihypertensive therapies, controlling for sociodemographic and clinical risk factors. Within the group of 1484 patients who had evidence of clinical depression in the 12 months prior to the initiation of antihypertensive therapy, the authors examined the relationship between drug therapy treatment for depression and 6-month persistence with antidepressant therapy with early nonpersistence with antihypertensive therapies. No association was found between the presence of clinical depression and early nonpersistence to antihypertensive therapies after adjustment for individual demographic and clinical characteristics and neighborhood-level socioeconomic status. However, among the subset of 1484 patients with documented evidence of clinical depression in the 12 months prior to the initiation of antihypertensive therapy, being prescribed and persistence with antidepressant therapy was strongly associated with lower odds of early nonpersistence to antihypertensive medications (odds ratio, 0.64; confidence interval, 0.42-0.96). In an integrated delivery system, the authors found that treatment for depression was associated with higher levels of antihypertensive persistence. Improving quality of depression care in patients with comorbid hypertension may be an important strategy in decreasing cardiovascular disease risk in these patients.
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Heidenreich PA, Lin S, Knowles JW, Perez M, Maddox TM, Ho MP, Rumsfeld JS, Sahay A, Massie BM, Tsai TT, Witteles RM. Variation in Use of Left Ventriculography in the Veterans Affairs Health Care System. Circ Cardiovasc Qual Outcomes 2013; 6:687-93. [DOI: 10.1161/circoutcomes.113.000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul A. Heidenreich
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Shoutzu Lin
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Joshua W. Knowles
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Marco Perez
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Thomas M. Maddox
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Michael P. Ho
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - John S. Rumsfeld
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Anju Sahay
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Barry M. Massie
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Thomas T. Tsai
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
| | - Ronald M. Witteles
- From the VA Palo Alto Health Care System, Palo Alto, CA (P.A.H., S.L., A.S.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (P.A.H., J.W.K., M.P., R.M.W.); VA Eastern Colorado Health Care System, Denver, CO (T.M.M., M.P.H., J.S.R., T.T.T.); and San Francisco VA Medical Center, San Francisco, CA (B.M.M.)
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Tsai TT, Pointer L, Ho MP, Fazel R, Nallamothu BK, Alman A, Maddox TM, Rumsfeld JS. Abstract 106: Determinants of Fluoroscopy time in Veterans Undergoing Cardiac Catheterization Procedures: Insights from the National VA Clinical Assessment, Reporting and Tracking (CART) Program. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Radiation exposure to Veterans from invasive cardiac procedures is high and accounts for a substantial proportion of their overall exposure from medical imaging. The patient, provider and hospital factors associated with increased fluoroscopy time are unclear.
Methods:
From the National VA CART program database of catheterization laboratories, we evaluated the distribution of fluoroscopy time in patients undergoing coronary angiography (CA), bypass graft angiography (BGA) and/or PCI. Using multivariable logistic regression, we evaluated the patient, provider and hospital factors associated with the highest quartile of fluoroscopy time.
Results:
We examined 87,658 CA, BGA and PCI procedures performed by 362 operators at 58 VA facilities from 2007 through 2010. There is wide variation in fluoroscopy time by operator regardless of procedure performed (Table 1). Multiple patient, provider and hospital factors were associated with fluoroscopy times in the highest quartile. Patient factors included age and a history of peripheral arterial disease; provider factors included operator volume and experience; and hospital factors included whether or not they were associated with a teaching program.
Conclusion:
In a large VA national registry of all cardiac catheterization procedures, fluoroscopy time is highly variable and dependent on multiple factors, many of which may be modifiable. Quality improvement programs targeted at modifiable behaviors may lead to decreased fluoroscopy times and thus radiation exposure for our veterans.
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