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Improving Lipid Evaluation and Management in Medicare Patients Hospitalized for Acute Myocardial Infarction
Monte Malach, MD, MACP, FACC;
John Quinley, MD, MPH;
Pascal James Imperato, MD, MACP, MPH & ; TM;
Marcia Wallen, MPH
Arch Intern Med. 2001;161:839-844.
Background The control of low-density lipoprotein cholesterol (LDL-C) levels in
patients with known coronary artery disease, particularly in those with acute
myocardial infarction, has been shown to reduce the rates of disease progression,
recurrent events, and mortality.
Objectives To evaluate and improve hospital-based processes for measuring and treating,
when necessary, LDL-C levels above 3.36 mmol/L (>130 mg/dL) in patients with
an acute myocardial infarction.
Design A nonrandomized retrospective baseline study followed by a collaborative
educational intervention with participating hospitals and a second nonrandomized
postintervention study.
Patients Four hundred six preintervention patients discharged from the hospital
alive after a confirmed acute myocardial infarction in 1996, and 498 postintervention
patients discharged from the hospital in 1999.
Interventions Performance of lipid profiles on admission to the hospital and during
hospitalization and drug and dietary interventions.
Results The measurement of LDL-C level on admission to the hospital increased
from 8% preintervention in 1996 to 32% postintervention in 1999. The measurement
during hospitalization increased from 14% preintervention to 48% postintervention.
Hospitals that initiated programs to ensure early lipid evaluations through
preprinted orders and policy changes achieved an average patient LDL-C measurement
rate of 70% in 1999. Hospitals lacking standard policies averaged only 23%
at the same time. Of the patients with a measured LDL-C level greater than
3.36 mmol/L (>130 mg/dL) who were not undergoing drug therapy on admission
to the hospital, 46% were given lipid-lowering agents by discharge from the
hospital during the postintervention period. During this same period, only
11% of the patients were prescribed this therapy if they had either a lower
measured level or no LDL-C measurement at all.
Conclusion Active hospital-based programs to ensure routine LDL-C measurements
in patients admitted for acute myocardial infarction increased the use of
appropriate lipid-lowering therapy in these high-risk individuals and could
contribute to reducing the incidence of recurrent coronary artery disease.
From IPRO, Lake Success, NY (Drs Malach, Quinley, and Imperato and
Ms Wallen); the Department of Medicine, New York University Medical Center,
New York (Dr Malach); and the Departments of Medicine (Dr Malach) and Preventive
Medicine and Community Health (Dr Imperato), State University of New York,
Health Science Center at Brooklyn.
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