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CARDIOLOGY

Assessment of Compliance with Lipid Guidelines in an Academic Medical Center

Clinical Pharmacy Specialist in Primary Care, Kaiser Permanente, Highlands Ranch, CO

Jean M Nappi, PharmD FCCP BCPS

Professor of Pharmacy and Clinical Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC

Kelly R Ragucci, PharmD BCPS CDE

Associate Professor of Pharmacy and Clinical Sciences/Family Medicine, Medical University of South Carolina

Reprints: Dr. Schwiesow, Kaiser Permanente, 9285 Hepburn St., Highlands Ranch, CO 80129-2262, fax 720/348-4365, sarah.j.schwiesow{at}kp.org

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.

Key Words: lipid-lowering therapy, treatment guidelines

Published Online, December 13, 2005. www.theannals.com, DOI 10.1345/aph.1G303

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