Improving lipid evaluation and management in medicare patients hospitalized for acute myocardial infarction.
BACKGROUND
The control of low-density lipoprotein cholesterol (LDL-C) levels in patients with known coronary artery disease, particularly in those with acute myocardial infarction, has been shown to reduce the rates of disease progression, recurrent events, and mortality.


OBJECTIVE
To evaluate and improve hospital-based processes for measuring and treating, when necessary, LDL-C levels above 3.36 mmol/L (>130 mg/dL) in patients with an acute myocardial infarction.


METHODS
A nonrandomized retrospective baseline study followed by a collaborative educational intervention with participating hospitals and a second nonrandomized postintervention study.


METHODS
Four hundred six preintervention patients discharged from the hospital alive after a confirmed acute myocardial infarction in 1996, and 498 postintervention patients discharged from the hospital in 1999.


METHODS
Performance of lipid profiles on admission to the hospital and during hospitalization and drug and dietary interventions.


RESULTS
The measurement of LDL-C level on admission to the hospital increased from 8% preintervention in 1996 to 32% postintervention in 1999. The measurement during hospitalization increased from 14% preintervention to 48% postintervention. Hospitals that initiated programs to ensure early lipid evaluations through preprinted orders and policy changes achieved an average patient LDL-C measurement rate of 70% in 1999. Hospitals lacking standard policies averaged only 23% at the same time. Of the patients with a measured LDL-C level greater than 3.36 mmol/L (>130 mg/dL) who were not undergoing drug therapy on admission to the hospital, 46% were given lipid-lowering agents by discharge from the hospital during the postintervention period. During this same period, only 11% of the patients were prescribed this therapy if they had either a lower measured level or no LDL-C measurement at all.


CONCLUSIONS
Active hospital-based programs to ensure routine LDL-C measurements in patients admitted for acute myocardial infarction increased the use of appropriate lipid-lowering therapy in these high-risk individuals and could contribute to reducing the incidence of recurrent coronary artery disease.
Malach
M
M
IPRO, 1979 Marcus Ave, Lake Success, NY 11042, USA. nypro.mmalach@sdps.org
Quinley
J
J
Imperato
P J
PJ
Wallen
M
M
D008078:Cholesterol, LDL / Q000097:blood; D002985:Clinical Protocols; D003327:Coronary Disease; D006760:Hospitalization; D006761:Hospitals / Q000592:standards*; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D006278:Medicare; D008991:Monitoring, Physiologic / Q000592:standards*; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents