Cholesterol Management in Patients Hospitalized for Coronary Heart Disease

Cholesterol Risk Management: A Systematic Examination of the Gap from Evidence to Practice

“…39 This practice would be consistent with Canadian, European, and British High cholesterol noted as a risk factor for CHD in 53% of and surveys of 184 physicians on knowledge, attitudes, charts; 18% of charts had complete lipid profile documented. and practice patterns 11 Retrospective chart audit of 100 consecutive inpatients Total cholesterol recorded for 83% of patients. with CHD under the care of three cardiac surgeons 12 Retrospective chart audit of 3304 inpatients with CHD Lipids documented in 28% of charts either during patient admitted to four acute care hospitals in 1993 13 hospital stay or anytime in 1988-1993.…”

“…34,35,[40][41][42][43] Data from numerous retrospective audits of medical records from both inpatients and outpatients with CHD indicate that only 64% (range 28-96%) of these high-risk individuals had cholesterol measurements documented ( Table 1). [11][12][13][14][15][16][17][18][19] Based on these data, approximately 36% (and as many as 72%) of patients with CHD are not screened for hypercholesterolemia. Two studies did report exceptionally high proportions of patients being screened: 93% 19 and 96%, 16 respectively; however, one used protocols and care maps to guide lipid management, 19 and the other included only those physicians who agreed to participate.…”

“…Although it is evident that the implementation of screening strategies for hypercholesterolemia is suboptimal, the proportion of patients screened seems to have increased over time. 11 Furthermore, screening practices appear to increase as patients move from primary to secondary prevention. 13,14 Still, improvements are needed to increase screening, at least for patients at the greatest risk for CHD events.…”

“…Given the suboptimal rate of screening for cholesterol risk, it is perhaps not surprising that many investigators suspect that patients are undertreated for hypercholesterolemia. [11][12][13][14][15][16][17][18][20][21][22][23][24][25][26][27] A 1993 study involving a database of 154,735 adults estimated that 72% of those eligible for lipid-lowering therapy with diet or drugs failed to receive either form of treatment. 23 Although this study was completed before the publication of the NCEP II guidelines and the pivotal statin trials, the rate is consistent with a 1998 survey of 7423 adults, which found that 71% of treatmenteligible patients in the general population received no therapy.…”

“…Method Percentage of Patients Started on Therapy Retrospective chart audit of 154 inpatients with CHD 53% of patients had elevated cholesterol; 11% treated with and surveys of 184 physicians on knowledge, attitudes, dietary therapy. and practice patterns 11 Retrospective chart audit of 100 consecutive inpatients Overall, 36% of patients referred to dietician; 29% of patients with CHD under the care of three cardiac surgeons 12 with total cholesterol > 259 mg/dl (6.7 mmol/L) were referred to dietician; 14% were treated with drug therapy. Retrospective chart audit of 3304 inpatients with CHD 22% were prescribed dietary therapy; 5% had lifestyle admitted to four acute care hospitals in 1993 13 adjustments recommended; 8% were prescribed drugs.…”