Session number: 1010
Abstract title: Adverse outcomes in ischemic heart disease patients who do not undergo a lipid measurement
Author(s):
PM Ho - Denver VA Medical Center, University of Colorado Health Sciences Center
H Starks - IHD QUERI, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA
H Sun - IHD QUERI, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA
K Sloan - IHD QUERI, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA
A Sales - IHD QUERI, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA
C Maynard - IHD QUERI, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA
Objectives: Lipid profiles are essential in guiding lipid-lowering therapy and assessing concordance with recommended LDL levels. Our objectives were to identify ischemic heart disease (IHD) patients at risk for not undergoing a LDL measurement and to determine if there were any adverse consequences.
Methods: This was a prospective cohort study of all IHD patients actively followed as of October 1, 1998 in the Northwest Network. The presence of a lipid profile was ascertained for a 15-month period prior to October 1, 1998. This was defined as the baseline period, while follow-up occurred through Decemeber 2000. Multivariate logistic regression was used to determine the predictors of not receiving a LDL measurement. Cox proportional hazards regression was used to identify predictors of survival during the follow-up period.
Results: 12,135 IHD patients were identified, and 40.8% of these patients did not have a LDL measurement. Patients without a LDL measurement were older, had fewer clinic visits and were more likely to have a history of COPD and CHF compared to patients with a LDL measurement. In logistic regression analysis, predictors of not receiving a LDL measurement were increasing age, residence > 25 miles from the medical center, African-American race, a history of COPD, and a history of depression. During one-year follow-up, patients without a LDL measurement had lower survival (89% vs 95%, p < 0.0001) and higher hospitalization rates (34% vs 29%, p < 0.0001). In Cox regression analysis, the absence of a LDL measurement during the baseline period was associated with a 36% lower one-year survival.
Conclusions: Current studies mainly focus on concordance with target LDL levels. Based on our results, however, a significant proportion of IHD patients are excluded from these studies because they do not have a current LDL measurement. We identified selected characteristics of IHD patients predictive for not undergoing a LDL measurement, and these patients had higher mortality. Future studies should explore reasons why these patients have increased morbidity and mortality.
Impact statement: We identified a group of IHD patients at risk for not undergoing a lipid measurement. Future quality improvement projects should focus on increasing the rates of lipid measurement in these high-risk patients.