title: Optimizing secondary prevention: Statin prescribing across East and West London in accordance with NICE guidelines.
abstract: OBJECTIVE
  Statins are a well-known primary and secondary prevention drug for cardiovascular disease and NICE guidelines have been issued to identify key indicators for their use. An audit looking into statin prescribing for medical inpatients was carried out in two geographically distinct London hospitals.
  
  
  METHODS
  A prospective inpatient audit of medical prescription charts was performed. Blood results were reviewed for the inpatients during their admission to identify any contraindications for statin usage (rhabdomyolysis). The medical notes were also reviewed for patient refusal of statin therapy.
  
  
  METHODS
  The study was carried out at two distinct hospitals in London. Whipps Cross University Hospital (WCUH) and Chelsea & Westminster Hospital (CWH) are located in East London and West London, respectively. Acute medical, surgical, obstetrics and gynaecology, paediatric and palliative wards were excluded.
  
  
  METHODS
  A total of 309 inpatient medical notes and prescription chart data were collected from WCUH (n = 211) and CWH (n = 98).
  
  
  METHODS
  High percentage of hospitalized patients are not prescribed statins despite clear clinical indications for their use. Regardless of geographical and socioeconomic factors between hospitals, statin prescribing remains suboptimal.
  
  
  RESULTS
  The patient demographics in both hospitals were very similar; the mean age at WCUH was 78 ± 15 1SD while at CWH the mean age was 74 ± 15 1SD. The results showed that approximately one-third of patients (30% at WCUH and 33% at CWH) had at least one indication for statin therapy according to NICE guidelines and yet they were not prescribed a statin. Ten percent of patients at WCUH and 13% of patients at CWH had ischaemic heart disease (IHD) and yet were not prescribed statins.
  
  
  CONCLUSIONS
  Statin prescription is often overlooked in secondary care with patients being discharged without the appropriate assessment (NICE guidelines), which subsequently means repeat prescriptions are not provided by the GP. This study is the first to show that this problem is not due to resources or geography, but is inherent within the NHS system. Consequently, a revised prescription chart checking system has been suggested for pharmacists and junior doctors.
authors.affiliation: Department of Medical Education, Barts and The London School of Medicine and Dentistry , London , UK.
authors.forename: Rameen
authors.initials: R
authors.lastname: Shakur
authors.forename: Santron
authors.initials: S
authors.lastname: Sathasivam
authors.forename: Chris
authors.initials: C
authors.lastname: Yu
authors.forename: Ivan
authors.initials: I
authors.lastname: Cheung
authors.forename: Aran
authors.initials: A
authors.lastname: Selvakumaran
authors.forename: Cholan
authors.initials: C
authors.lastname: Anandarajah
authors.forename: Amreen
authors.initials: A
authors.lastname: Shakur
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kaler
authors.forename: Geraldine
authors.initials: G
authors.lastname: McElligott