title: Secondary prevention in a cardiology group practice and hospital setting after a heart-care initiative.
abstract: The American Heart Association (AHA) Consensus Panel Statement for Preventing Heart Attack and Death in Patients with Coronary Disease provides recommendations for the secondary prevention of heart disease in at-risk patients. Blackstone Cardiology Associates of Pawtucket, Rhode Island, undertook an initiative in their practice implementing secondary-prevention guidelines in patients with coronary artery disease. This retrospective study evaluates practice patterns for the management of hyperlipidemia for a cardiology group in an ambulatory and hospital setting after the institution of a physician-supervised, nurse-based disease management program. Practice patterns in patients with established coronary heart disease treated in a lipid center compared with non-lipid-center settings were evaluated. Parameters evaluated included documenting low-density lipoprotein (LDL) cholesterol, presence of lipid-lowering therapy, and achieving the National Cholesterol Education Program II (NCEP II) goal of LDL-cholesterol levels < or =100 mg/dL in patients with preexisting coronary artery disease. A total of 352 patients met inclusion criteria in the lipid-center setting and were compared with 289 non-lipid-center consecutively chosen patients. Age and gender differences were also evaluated. Inpatient medical records from a 254-bed Brown University-affiliated teaching hospital were also evaluated for lipid profile, achievement of NCEP II goal, and use of lipid-lowering medication on admission and discharge. The most recent LDL-cholesterol values of patients followed in the lipid-center and in the non-lipid-center setting of the Blackstone Cardiology Associates were compared. Blackstone Cardiology Associates consists of 4 cardiologists and 4 advanced-practice nurses. Achievement of LDL-cholesterol goal was higher in both the lipid-center and non-lipid-center settings compared with baseline. A smaller percentage of patients at goal in the lipid setting is likely due to referral bias resulting in patients with more difficult-to-manage mixed dyslipidemias and behavior-management issues ending up in the lipid center. There were no apparent sex differences at goal, and more elderly (age > or =65 years) achieved goal in the lipid clinic center. In the non-lipid-center setting, more males were at goal and had a lower mean LDL-cholesterol level.
authors.affiliation: Blackstone Cardiology Associates, Pawtucket, Rhode Island 02860, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: LaBresh
authors.forename: P
authors.initials: P
authors.lastname: Owen
authors.forename: C
authors.initials: C
authors.lastname: Alteri
authors.forename: S
authors.initials: S
authors.lastname: Reilly
authors.forename: P S
authors.initials: PS
authors.lastname: Albright
authors.forename: A R
authors.initials: AR
authors.lastname: Hordes
authors.forename: P A
authors.initials: PA
authors.lastname: Shaftel
authors.forename: T E
authors.initials: TE
authors.lastname: Noonan
authors.forename: C A
authors.initials: CA
authors.lastname: Stoukides
authors.forename: A F
authors.initials: AF
authors.lastname: Kaul
mesh_terms: D000368:Aged; D002309:Cardiology / Q000379:methods*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006123:Group Practice; D006266:Health Education; D006785:Hospitals, University; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D008297:Male; D010045:Outpatients; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents