Guideline Recommended Medical Therapy for Cardiovascular Diseases in the Obese: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program.

BACKGROUND: Stigma against the obese is well described in health care and may contribute to disparities in medical decision-making. It is unknown whether similar disparity exists for obese patients in cardiovascular care. We evaluated the association between body mass index (BMI) and prescription of guideline-recommended medications in patients undergoing elective percutaneous coronary intervention. METHODS AND RESULTS: Using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking System Program, we identified patients undergoing elective percutaneous coronary intervention from 2007 to 2012, stratifying them by category of BMI. We described rates of prescription for class I guideline recommended medications for each BMI category (normal, overweight, and obese). Multivariable logistic regression assessed the association between BMI category and medication prescription. Seventeen thousand thirty-seven patients were identified, with 35.3% having overweight BMI, and 50.8% obese BMI. Obese patients were more likely than normal BMI patients to be prescribed ß-blockers (OR 1.34), statins (OR 1.39), or ACE/ARB (odds ratio [OR] 1.52; all significant) when indicated. Overweight patients were more likely than normal BMI patients to be prescribed statins (OR 1.29) and angiotensin-converting enzymes/angiotensin II receptor blockers (OR 1.41) when indicated. There was no association between BMI category and prescription of anticoagulants. CONCLUSIONS: Over 85% of patients undergoing elective percutaneous coronary intervention in the Veterans Affairs are overweight or obese. Rates of guideline-indicated medication prescription were <70% among all patients, and across BMI categories, with an association between increased BMI and greater use of guideline-recommended medications. Our findings offer a possible contribution to the obesity paradox seen in many cardiovascular conditions.

Validation of the Urgency, Weak stream, Incomplete emptying, and Nocturia (UWIN) score compared with the American Urological Association Symptoms Score in assessing lower urinary tract symptoms in the clinical setting.

OBJECTIVE: To validate the Urgency, Weak stream, Incomplete emptying, and Nocturia (UWIN) survey for patients with lower urinary tract symptoms (LUTS) by comparison with the American Urological Association Symptoms Score (AUA-SS). The hypothesis is that the UWIN will perform as well as the AUA-SS in assessing LUTS symptoms and quality of life. The AUA-SS is complex for many patients and can be misunderstood. The UWIN questionnaire was developed to serve as a simpler and shorter version of the AUA-SS, with the intent of improving accuracy and minimizing error in assessing LUTS. The UWIN consists of 4 questions scored 0-3 to give a maximum score of 12. METHODS: We screened 700 patients in the urology clinic between 2011 and 2012. We enrolled 593 patients who completed the AUA-SS survey and UWIN in the same clinic visit. The AUA-SS and UWIN responses were evaluated using Spearman correlation coefficients and Bland-Altman graphs. RESULTS: Correlation coefficients were calculated between the corresponding AUA-SS and UWIN items on 593 matched surveys, demonstrating a strong correlation coefficient of 0.81 or greater for each question, which was statistically significant (P <.0001). The correlation coefficient between the total scores of the AUA and UWIN was 0.89 (P <.01). A second analysis was performed using Bland-Altman plots between AUA-SS and UWIN including total score, quality of life, and categories, which showed a good agreement. CONCLUSION: The UWIN appears to provide results comparable to the AUA-SS, while using a simpler format and taking less time to complete.