Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization.
BACKGROUND
Published data indicate that there is a significant treatment gap between the evidence for and the implementation of lipid-lowering therapy and that recidivism is as high as 60% at 1 year. The aim of this study is to examine the impact of a clinical pharmacy cardiac risk service (CPCRS) on lipid screening, control, and treatment outcomes.


METHODS
A computer-generated list of all patients with documented coronary artery disease, enrolled in a CPCRS between March 1, 1998, and October 1, 2002, and followed up for a minimum of 6 months was obtained. Outcome measures were the percentage of patients with up-to-date lipid screening results and the percentage achieving low-density lipoprotein cholesterol (LDL-C) goals at enrollment in CPCRS and at study end.


RESULTS
A total of 8014 patients (mean age, 69.3 years; 69.8% men) met the entry criteria. The mean duration of follow-up was 2.3 years. Most patients (97.3%) had up-to-date lipid screening results at study end compared with 66.9% of patients at baseline. At study end, a total of 72.9% of patients achieved a LDL-C level of less than 100 mg/dL (<2.6 mmol/L) compared with 25.5% at baseline. The mean +/- SD LDL-C level for the cohort at study end was 89 +/- 24 mg/dL (2.3 +/- 0.6 mmol/L). Of patients receiving medication, most (84.8%) were receiving therapy with statins alone, whereas 11.7% were receiving combination therapy.


CONCLUSIONS
A CPCRS working in conjunction with a patient-tracking system can achieve improved lipid results in a large and inclusive cohort of patients with coronary artery disease. Our approach is unique in that the results were sustainable and demonstrate reduced recidivism.
Olson
Kari L
KL
Departments of Pharmacy, Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente Colorado Region, Aurora, CO 80211, USA. kari.olson@kp.org
Rasmussen
Jon
J
Sandhoff
Brian G
BG
Merenich
John A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects*; D015331:Cohort Studies; D003120:Colorado; D003324:Coronary Artery Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services; D010595:Pharmacists; D011314:Preventive Health Services; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents