Determinants of appropriate lipid management in patients with ischaemic heart disease. Cracovian Program for Secondary Prevention of Ischaemic Heart Disease.
Although several randomised clinical trials have documented the efficacy of lipid-lowering therapy in improving clinical outcomes in hyperlipidemic subjects with ischaemic heart disease (IHD), such therapy is underutilized worldwide. Not much is known about the effects of the hospital setting (university vs. community) on lipid management in patients after hospitalization due to ischaemic heart disease. The combined effect of age, sex, education, risk factors, hospital as well as practice setting in the post-discharge period on lipid management in IHD patients is also unknown. Therefore the aim of this study was to evaluate factors influencing lipid management during and after hospitalization due to IHD. The primary outcome measure was "appropriate lipid management", defined as: (a) being discharged on lipid-lowering medication or having a documented LDL cholesterol level <3.4 microM/l within the first 24 h of hospitalization, and (b) (for patients with hypercholesterolemia) being prescribed a lipid-lowering drug at the time of the interview 6-18 months after discharge.


RESULTS
We reviewed the hospital records of 1051 consecutive patients with a discharge diagnosis of acute myocardial infarction (N=290), unstable angina (N=247), percutaneous coronary intervention (N=259) or coronary artery bypass surgery (N=255) who were hospitalized at three university (N=533) or three community (N=518) cardiac departments. Overall, 42.2% of the study population met the criteria for appropriate lipid management during hospitalization. Admission to the university hospital, percutaneous coronary intervention, a history of myocardial infarction, the presence of hypertension, the absence of diabetes mellitus, and younger age were all associated with an increased probability of receiving proper treatment during hospitalization. During the follow-up interview (6-18 months after discharge), 10.4% patients had a LDL cholesterol level of <2.6 microM/l. The use of lipid-lowering agents in the group with hypercholesterolemia was 40.8%. Patients who met the criteria for appropriate lipid management during hospitalization were more often prescribed a lipid-lowering drug at the time of interview compared with persons who did not meet those criteria (62.5% vs. 23.5%; P<0.0001). Patients undergoing percutaneous coronary interventions, treated in hospital outpatient clinics, obese patients as well as those better educated were more likely to be treated appropriately than the other groups.


CONCLUSIONS
Proper lipid management during hospitalization is the most important factor related to lipid management in the post-discharge period. There is the potential for a further reduction of coronary risk, especially in patients hospitalized in community hospitals, not undergoing coronary interventions and those being under the care of general practitioners.
Kawecka-Jaszcz
Kalina
K
I Cardiac Department, Collegium Medicum, Jagiellonian University, ul. Kopernika 17, 31-501 Kraków, Poland.
Jankowski
Piotr
P
Pajak
Andrzej
A
D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007407:Interviews as Topic; D050356:Lipid Metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000378:metabolism / Q000517:prevention & control*; D009765:Obesity / Q000453:epidemiology; D011044:Poland / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome
D000960:Hypolipidemic Agents