Low-Density Lipoprotein Cholesterol Levels in Coronary Artery Disease Patients: Opportunities for Improvement.
Journal
Cardiology research and practice
ISSN: 2090-8016
Titre abrégé: Cardiol Res Pract
Pays: United States
ID NLM: 101516542
Informations de publication
Date de publication:
2022
2022
Historique:
received:
25
01
2022
accepted:
15
04
2022
entrez:
9
5
2022
pubmed:
10
5
2022
medline:
10
5
2022
Statut:
epublish
Résumé
We sought to characterize the level of LDL-C control and identify opportunities for improvement and characteristics of patients who were undertreated. Study patients were from a large multihospital system, age <90, with documentation of at least two encounters with a CAD diagnosis or procedure before a first measured LDL-C level and a last recorded LDL-C measurement over a minimum six-month (median = 22 months, IQR = 15-26 months) follow-up from January 2017 to September 2019. Linear regression analysis for last recorded LDL-C level was used to analyze the effects of statin intensity and patient characteristics. Among 15,111 eligible patients, mean age was 68.4 (SD = 10.8), 68.7% were male, and 79.4% were non-Hispanic White. At follow-up, 87.8% of patients were prescribed a statin, 9.7% were on ezetimibe, and 0.5% were on a PCSK9 inhibitor. Mean LDL-C at follow-up was 75.6 mg/dL and 45.5% of patients were on high-intensity treatment. Higher LDL-C values were associated with female sex, younger patients, non-Hispanic Black patients, high poverty or out of state zip code, Medicaid, or angina as the qualifying diagnosis. For 332 clinicians with >10 patients in the cohort, mean last recorded LDL-C values ranged from 47 to 102 mg/dL. There were important variations in LDL-C control between patients in our health system with the same indication for treatment. Variation in treatment among physicians is an area ripe for quality improvement interventions. This study may be easily reproduced by other medical centers and used for highlighting both patient and physician opportunities for improvement.
Sections du résumé
Background
UNASSIGNED
We sought to characterize the level of LDL-C control and identify opportunities for improvement and characteristics of patients who were undertreated.
Methods
UNASSIGNED
Study patients were from a large multihospital system, age <90, with documentation of at least two encounters with a CAD diagnosis or procedure before a first measured LDL-C level and a last recorded LDL-C measurement over a minimum six-month (median = 22 months, IQR = 15-26 months) follow-up from January 2017 to September 2019. Linear regression analysis for last recorded LDL-C level was used to analyze the effects of statin intensity and patient characteristics.
Results
UNASSIGNED
Among 15,111 eligible patients, mean age was 68.4 (SD = 10.8), 68.7% were male, and 79.4% were non-Hispanic White. At follow-up, 87.8% of patients were prescribed a statin, 9.7% were on ezetimibe, and 0.5% were on a PCSK9 inhibitor. Mean LDL-C at follow-up was 75.6 mg/dL and 45.5% of patients were on high-intensity treatment. Higher LDL-C values were associated with female sex, younger patients, non-Hispanic Black patients, high poverty or out of state zip code, Medicaid, or angina as the qualifying diagnosis. For 332 clinicians with >10 patients in the cohort, mean last recorded LDL-C values ranged from 47 to 102 mg/dL.
Conclusions
UNASSIGNED
There were important variations in LDL-C control between patients in our health system with the same indication for treatment. Variation in treatment among physicians is an area ripe for quality improvement interventions. This study may be easily reproduced by other medical centers and used for highlighting both patient and physician opportunities for improvement.
Identifiants
pubmed: 35529057
doi: 10.1155/2022/7537510
pmc: PMC9068326
doi:
Types de publication
Journal Article
Langues
eng
Pagination
7537510Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001422
Pays : United States
Informations de copyright
Copyright © 2022 Gary J. Martin et al.
Déclaration de conflit d'intérêts
The authors declare that they have no conflicts of interest.
Références
JAMA Netw Open. 2020 Aug 3;3(8):e2011051
pubmed: 32816031
JMIR Med Inform. 2020 Apr 2;8(4):e16400
pubmed: 32238333
J Clin Lipidol. 2013 Nov-Dec;7(6):573-609
pubmed: 24314357
JAMA. 2016 Sep 27;316(12):1289-97
pubmed: 27673306
J Am Coll Cardiol. 2021 Mar 9;77(9):1182-1193
pubmed: 33663735
J Am Coll Cardiol. 2021 Mar 23;77(11):1451-1453
pubmed: 33736828
Gastrointest Endosc. 2020 Aug;92(2):355-364.e5
pubmed: 32092289
Eur Heart J. 2017 Aug 21;38(32):2459-2472
pubmed: 28444290
Eur Heart J. 2020 Jan 1;41(1):111-188
pubmed: 31504418
JAMA Intern Med. 2013 Jan 14;173(1):38-43
pubmed: 23403978
Swiss Med Wkly. 2020 May 27;150:w20244
pubmed: 32459361
J Am Heart Assoc. 2012 Dec;1(6):e001800
pubmed: 23316314
Lancet Diabetes Endocrinol. 2020 Jan;8(1):36-49
pubmed: 31862150
Eur Heart J. 2020 Jul 21;41(28):2618-2628
pubmed: 32702746
J Cardiovasc Dev Dis. 2021 Sep 18;8(9):
pubmed: 34564134
Eur J Prev Cardiol. 2020 Jun 02;:
pubmed: 33611546
JAMA Netw Open. 2020 Nov 2;3(11):e2025505
pubmed: 33216139
N Engl J Med. 2015 Jun 18;372(25):2387-97
pubmed: 26039521
JAMA. 2021 Jul 20;326(3):266-267
pubmed: 34283191
J Am Coll Cardiol. 2017 Feb 28;69(8):1076-1092
pubmed: 28132746
N Engl J Med. 2020 Jan 2;382(1):9
pubmed: 31738483
Am J Gastroenterol. 2015 Aug;110(8):1134-9
pubmed: 25869388
Prev Med. 2014 Aug;65:65-9
pubmed: 24806331
JAMA. 2006 Apr 5;295(13):1556-65
pubmed: 16533939
J Am Coll Cardiol. 2021 Jun 15;77(23):2973-2977
pubmed: 34112323
N Engl J Med. 2018 Nov 29;379(22):2097-2107
pubmed: 30403574
Atherosclerosis. 2021 May;324:141-147
pubmed: 33810858
N Engl J Med. 2017 May 4;376(18):1713-1722
pubmed: 28304224
Lancet. 1994 Nov 19;344(8934):1383-9
pubmed: 7968073
Can J Cardiol. 2019 Jul;35(7):884-891
pubmed: 31292087
J Am Coll Cardiol. 2020 May 5;75(17):2119-2121
pubmed: 32209335
J Gen Intern Med. 2013 Apr;28(4):554-60
pubmed: 23143672
Eur Heart J. 2016 May 01;37(17):1373-9
pubmed: 26916794
J Am Coll Cardiol. 2021 Jun 22;77(24):3016-3027
pubmed: 34140105
J Am Coll Cardiol. 2019 Jun 25;73(24):3168-3209
pubmed: 30423391
Expert Opin Pharmacother. 2009 Dec;10(18):2973-85
pubmed: 19954271
Am J Med Qual. 2014 Jul-Aug;29(4):308-14
pubmed: 23939486
N Engl J Med. 2014 May 15;370(20):1957
pubmed: 24827050
JAMA Netw Open. 2020 Apr 1;3(4):e203032
pubmed: 32301989