Non-attendance at secondary prevention clinics: the effect on lipid management.
BACKGROUND
Secondary prevention of coronary artery disease is effective in reducing morbitiy and mortality. Our aim was to assess lipid management following non-attendance to a hospital based secondary prevention clinic.


METHODS
Data were collected over 5 years on statin usage and total cholesterol levels for patients with coronary artery disease following attendance at a cardiac nurse led outpatient clinic. Lipid levels were taken from a central laboratory database, for both patients discharged from clinic and non-attenders.


RESULTS
From 935 inpatients discharged from hospital, 248 (29%) defaulted from outpatient follow up. Lipid lowering drug usage was similar (72% vs. 74% for non-attenders, p=NS). Attenders at the nurse led outpatient clinic were more likely to achieve a total cholesterol <5 mmol/L at discharge than non-attenders (70% vs. 43%; p < 0.001), with a lower mean total cholesterol (4.75 +/- 0.06 mmol/L vs. 5.33 +/- 0.08 mmol/L; p < 0.001). Non-attenders subsequently had a greater number of cholesterol measurements than those who were discharged from the hospital based clinic (range 0-12, c2 23.8 on 12 df p < 0.005). Lipid profiles in hospital non-attenders remained inferior with fewer achieving a total cholesterol <5 mmol/L (61% vs. 78%; p < 0.001), and having greater mean total cholesterol levels (4.85 +/- 0.06 mmol/L vs. 4.52 +/- 0.05 mmol/L; p < 0.001).


CONCLUSIONS
Patients defaulting from hospital follow up have higher total cholesterols with fewer at target level compared to attenders. Though non-attenders receive subsequent lipid measurement, inferior lipid profiles persist compared to patients who completed hospital follow up to be discharged. Further implementation strategies are needed with regard to lipid management in this patient group.
Department of Cardiology, OPD3, New Royal Infirmary of Edinburgh at Little France, Edinburgh. a.mcleod@ed.ac.uk
A L
AL
McLeod
L
L
Brooks
V
V
Taylor
A
A
Wylie
P F
PF
Currie
N G
NG
Dewhurst
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy / Q000517:prevention & control*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007407:Interviews as Topic; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids; D002784:Cholesterol