Impact of routine in-hospital assessment of low-density lipoprotein levels and standardized orders on statin therapy in patients undergoing percutaneous coronary interventions.
BACKGROUND
Previous studies have shown that a significant proportion of patients undergoing percutaneous coronary intervention (PCI) are not receiving guideline-recommended statin therapy upon hospital discharge. We evaluated the impact of the implementation of routine cholesterol profile measurements and standardized orders post-PCI on the number of patients receiving statin therapy.


METHODS
We conducted a prospective, observational study on all patients undergoing PCI in an urban teaching hospital from February 2002 to March 2003. Patient baseline characteristics, statin therapy pre- and post-PCI, and fasting lipid profiles were recorded as part of an ongoing PCI database. A similar cohort of patients undergoing PCI in the one-year time period immediately before the intervention was used as a comparison group.


RESULTS
A total of 1,748 patients underwent PCI during the study period. Statin therapy was prescribed in 78% of patients pre-PCI and increased to 92% at hospital discharge. In the year before implementation of the standardized post-PCI orders, there was only a 5% absolute increase in statin use after PCI compared to a 14% absolute increase in the study time period (p = < 0.0001). Low-density lipoprotein (LDL) levels were available in 1,268 patients. The median LDL level was 2.08 mmol/L for patients on statin therapy versus 2.40 mmol/L for those not on statins.


CONCLUSIONS
Routine assessment of LDL levels and lipid-lowering therapy at the time of PCI resulted in a further increase in statin use. However, approximately one-third of patients still had an LDL level above recommended guidelines for secondary prevention.
Ahmad
Mayraj
M
Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Schwalm
Jon-David
JD
Velianou
James L
JL
Natarajan
Madhu K
MK
D015906:Angioplasty, Balloon, Coronary; D002985:Clinical Protocols; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000188:drug therapy*; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL