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2004 National Healthcare Quality Report

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Findings

Awareness, Treatment, and Control of Cholesterol

High blood cholesterol is an important risk for heart disease. The major culprit is LDL cholesterol which makes up 60%-70% of the total cholesterol. When elevated, cholesterol, a fat-like substance, builds up in the walls of the arteries and causes them to narrow, and slow down or block the flow of needed blood and oxygen to the heart. High cholesterol is one of the major risk factors for heart attacks.

Figure 2.9. Cholesterol screening, awareness and control, 1988-94 and 1999-2000

Figure 2.9. Cholesterol screening, awareness and control, 1988-94 and 1999-2000

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Source: National Health and Nutrition Examination Survey, 1988-94 and 1999-2000.

Note: Percentages are age adjusted. Data on cholesterol screening are not available from the National Health Interview Survey for the 2004 NHQR. The above measures from NHANES have been included as supplemental measures to the 2004 NHQR to allow reporting on cholesterol screening.

  • Progress has been made in raising awareness of the importance of cholesterol screening and in patients' knowledge of their own cholesterol levels between 1988-94 and 1999-2000.
  • In addition, more adults with high cholesterol are taking medication to help control it and more adults with hypertension actually have their cholesterol under control.
  • Additional progress has been made in addressing heart disease risk factors for patients with other conditions. For example, the percent of patients with diabetes and high cholesterol who have their cholesterol under control has increased over 2.5 times.
  • However, still more than three-fourths of adults with high cholesterol are not taking any medication for their condition and nearly three-quarters of adults with high cholesterol do not have it under control (Figure 2.9).

Administration of Beta-Blockers to Heart Attack Patients

For those people who get to the hospital in time, treatments for heart attack (acute myocardial infarction, or AMI) and heart failure that are based on scientific evidence and knowledge of contraindications are crucial in saving lives and preventing disability 7, 8. Beta-blockers protect the heart by slowing the heart and helping the heart use less energy to pump blood.

Figure 2.10. Percent of Medicare AMI patients with a beta-blocker prescribed when leaving hospital, 2000-2001 and 2001-2002

Figure 2.10. Percent of Medicare AMI patients with a beta-blocker prescribed when leaving hospital, 2000-2001 and 2001-2002

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Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program.

  • The total percentage of patients receiving beta-blockers at discharge improved from 78.54% in 2000-2001 to 81.54% in 2001-2002 (Figure 2.10).
  • The percentages of men and women receiving beta-blockers at discharge improved during 2000-2002, but the lower rates for women persisted.
  • The rates for patients under age 65 and age 75 and older improved but the rate for patients ages 65 to 74 remained the same.

Administration of ACE Inhibitors to Heart Failure Patients

Generally, when an individual has clinical heart failure, the left ventricle—the strongest pumping muscle of the heart—is not functioning adequately. A type of medication called an acetyl-cholinesterase (or ACE) inhibitor has been found to improve survival and slow or prevent further loss of the heart's pumping ability.

Figure 2.11. Percent of acute heart failure Medicare patients with LV systolic dysfunction who were prescribed ACE inhibitor when leaving hospital, 2000-2001 and 2002

Figure 2.11. Percent of acute heart failure Medicare patients with LV systolic dysfunction who were prescribed ACE inhibitor when leaving hospital, 2000-2001 and 2002

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Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program.

  • The percentage of heart failure patients prescribed ACE inhibitors when leaving the hospital decreased over the 2000-2002 period (Figure 2.11).
  • The percentage of women leaving the hospital with prescriptions for ACE inhibitors also decreased and the lower rates for women persisted, even as the rates for men improved.
  • The percentage of patients prescribed ACE inhibitors decreased for patients age 75 and older during 2000-2002. Patients age 74 and younger have higher percentages than patients in the older age groups, with a marked improvement for patients less than 65 years of age.

 

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