Assessment of compliance with lipid guidelines in an academic medical center.
BACKGROUND
The importance of achieving a low-density lipoprotein cholesterol (LDL-C) level less than 100 mg/dL in patients with coronary artery disease (CAD) or cerebrovascular disease (CVD) is well established. Emerging evidence supports the recognition and management of secondary lipid goals, high-density lipoprotein cholesterol (HDL-C) level greater than 40 mg/dL, and triglyceride level less than 150 mg/dL.


OBJECTIVE
To evaluate whether inpatient services within an academic setting were achieving/addressing primary and secondary lipid goals in patients with established CAD or CVD.


METHODS
Patients with a discharge diagnosis of acute myocardial infarction, myocardial revascularization procedures, and/or ischemic stroke were identified. A retrospective chart review was done to assess adherence to the American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for lipid management.


RESULTS
On average, 63% of patients with CAD or CVD had a lipid panel assessed during their hospitalization. Of the patients who had a fasting lipid panel checked, only 40% (72/178) had an LDL-C level less than 100 mg/dL. Of those patients, only 31% (22) also had an HDL-C level greater than 40 mg/dL. Even fewer patients (24%; 17) met both primary and secondary goals. Of the 287 patients included in the study, 69% (199) were prescribed a statin, 3% (9) a fibrate, and 3% (8) niacin on discharge.


CONCLUSIONS
Few patients with CAD or CVD met the AHA/ACC goals for lipid management, yet a significant number were not prescribed appropriate lipid-lowering therapy at discharge. This finding strongly suggests that more awareness in this area is needed.
Schwiesow
Sarah J
SJ
Kaiser Permanente, Highlands Ranch, CO 80129-2262, USA. sarah.j.schwiesow@kp.org
Nappi
Jean M
JM
Ragucci
Kelly R
KR
D000046:Academic Medical Centers; D000572:American Heart Association; D015906:Angioplasty, Balloon, Coronary; D002561:Cerebrovascular Disorders / Q000097:blood / Q000628:therapy; D008078:Cholesterol, LDL / Q000097:blood* / Q000592:standards; D002995:Clofibric Acid / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007297:Inpatients / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy; D009525:Niacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D012955:Societies, Medical / Q000458:organization & administration / Q000592:standards; D016896:Treatment Outcome; D014481:United States
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009525:Niacin; D002995:Clofibric Acid