Low incidence of assessment and modification of risk factors in acute care patients at high risk for cardiovascular events, particularly among females and the elderly. The Clinical Quality Improvement Network (CQIN) Investigators.
This study defined the patterns of investigation and treatment of serum lipids and other modifiable risk factors for atherosclerosis among 3,304 hospitalized patients at high risk for future cardiovascular events. There were 2,161 men and 1,143 women; 1,955 were aged < 70 years, and 1,349 were aged > or = 70 years. Acute (61%) and chronic (65%) cardiac ischemia was the most prevalent reason for high-risk status, followed by cardiac revascularization (46%) and diabetes (28%). Only 28% of patients had lipid measurements recorded during their hospital stay, or recorded at any time between 1988 and 1993. A lipid-lowering diet or drugs were prescribed for 22% and 8% of all patients, respectively, and an adjustment in lifestyle in only 5% of all patients. Moreover, measurement and therapy of lipid risk were recorded less frequently in older patients (p < 0.01), and less often in women (p < 0.01). Logistic regression analysis revealed admission for revascularization, preadmission lipid-lowering or lifestyle therapies, and history of hyperlipidemia or diabetes to be associated with increased likelihood of in-hospital lipid measurement; age > or = 70 years was associated with reduced likelihood of lipid determinations (p < 0.01). The overall investigation and therapy of serum lipids and other risk factors in acute care patients at high risk for cardiovascular events appear less than optimal. Moreover, there is significantly fewer measurements and less treatment of risk factors in women and older patients. Improvement in these practice patterns would improve patient outcomes for the most important diseases in society.
D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D001161:Arteriosclerosis / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution
D008055:Lipids