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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2005;165:2052.
Left Ventricular Assessment in Myocardial Infarction
Assessment of left ventricular (LV) function has been recommended as a quality metric of care in patients with a myocardial infarction, especially those complicated by heart failure. However, it is unknown how often LV function is assessed with either echocardiography or cardiac catheterization in this setting or how much international variation exists. Furthermore, the link between the process of LV assessment and other performance measures or other end points is also unknown. Therefore, Hernandez et al analyzed the frequency of LV assessment and its association with quality of care using an international registry of patients with an acute myocardial infarction that accompanied the Valsartan in Acute Myocardial Infarction (VALIANT) trial.
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Disparities Despite Coverage
Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. Using the Medicare Current Beneficiary survey linked with claims, O’Malley and colleagues identified determinants of racial and socioeconomic disparities in CRC screening among beneficiaries with a usual physician. Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status. Socioeconomic disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31) were associated with higher odds of screening. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills.
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Racial Disparities in Hypertension Prevalence, Awareness, and Management
Improved control of risk factors, specifically hypertension, is an important method for eliminating racial disparities in cardiovascular health. In this report, Hertz et al analyzed data from the National Health and Nutrition Examination Surveys (NHANES) 1999-2002 and III (1988-1994). Using the most recent survey data, they confirmed higher prevalence (41.4% vs 28.1%), awareness (77.7% vs 70.4%), and treatment rates (68.2% vs 60.4%) in black patients, the latter 2 rates being driven by higher rates in black women. Although control rates among those pharmacologically treated have increased in both races since NHANES III (17.6% in blacks and 24.2% in whites), primarily as a result of increased control in black and white men, treated black patients are less likely than white patients to reach blood pressure goal. The disparity in control among those treated has increased over time, and currently 48.9% of blacks and 59.7% of whites reach treatment goal. The higher hypertension prevalence in blacks and the growing disparity in control among those treated are causes for concern.
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Reduced Screening Mammography Among Women With Diabetes
Chronic disease such as diabetes may pose a barrier to preventive care. Using population-based data from Ontario, Canada, Lipscombe and colleagues examined the effect of diabetes on screening mammogram rates among 731 687 women aged 50 to 67 years over a 2-year period. The authors found that despite a higher number of physician visits, diabetes was associated with an estimated 30% reduction in mammograms when compared with women without diabetes. This was not explained by age, income, or comorbidity status. These results suggest that the complexity involved in diabetes care may lead to neglect of routine primary care such as cancer screening.
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Cardiorespiratory Fitness and BMI as Predictors of CVD Mortality Among Men With Diabetes
Questions remain as to whether higher levels of cardiorespiratory fitness are associated with lower risk of cardiovascular disease (CVD) mortality in overweight and obese individuals with diabetes. In this prospective epidemiological study of 2316 men with diabetes, Church et al sought to quantify the independent and joint relations of cardiorespiratory fitness and body mass index with CVD mortality. They found that low cardiorespiratory fitness was associated with increased risk of CVD mortality within normal weight, overweight, and class 1 obese weight categories. These results further reinforce that health care providers should give increased attention to counseling for increasing activity and improving fitness in patients with diabetes for the intrinsic benefits associated with increased fitness and for the critical role regular physical activity plays in long-term weight loss and maintenance.
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