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Clifton R. Lacy, MD; Dong-Churl Suh, PhD; Joseph A. Barone, PharmD; Maureen Bueno, PhD; Deana Moylan, PharmD; Carla Swartz, BS; Ramanasri V. Kudipudi, MD; John B. Kostis, MD

Arch Intern Med. 2002;162:468-473.

Background  Although lipid-lowering therapy according to the National Cholesterol Education Program guidelines decreases mortality and morbidity in patients with coronary artery disease (CAD), significant undertreatment of hyperlipidemia continues to occur. This study was designed to determine the impact of an intervention targeted at improving the use of lipid-lowering therapy in patients with CAD in the hospital setting.

Methods  Cardiac case managers prompted physicians to obtain lipid profiles for patients with CAD who were not receiving lipid-lowering therapy on admission and initiate lipid-lowering therapy for patients with a low-density lipoprotein level of 130 mg/dL (3.37 mmol/L) or higher during hospitalization. The study population comprised 813 patients with CAD admitted for percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, or myocardial infarction. A retrospective chart review of lipid testing and treatment rates was conducted in 300 patients in the preintervention period, and a prospective review of rates was conducted in 513 patients during the intervention period.

Results  The percentage of patients with CAD not receiving lipid-lowering therapy on admission who had fractionated lipid profiles obtained during hospitalization increased from 27% preintervention to 89% during intervention (odds ratio, 18.27; 95% confidence interval, 11.61-28.74; P<.001). The percentage of patients with a low-density lipoprotein level of 130 mg/dL or higher for whom lipid-lowering therapy was initiated during hospitalization increased from 17% preintervention to 82% during intervention (odds ratio, 24.50; 95% confidence interval, 7.33-81.83; P<.001).

Conclusions  The intervention provided by specialized cardiac case managers significantly increased physicians' adherence to the National Cholesterol Education Program treatment guidelines. The results of the present study suggest that intervention programs of this nature could produce a significant positive impact on cardiovascular outcomes if implemented nationally.

From the Center for Disease Management and Clinical Outcomes, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick (Drs Lacy, Bueno, Moylan, Kudipudi, and Kostis and Ms Swartz); Robert Wood Johnson University Hospital, New Brunswick, NJ (Drs Lacy, Bueno, and Kostis); and Rutgers–The State University of New Jersey, College of Pharmacy, Piscataway (Drs Lacy, Suh, and Barone).

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