2017. Missed Opportunities to Treat High Lipid Levels in Male VA Patients with Ischemic Disease
B Kopjar, University of Washington, AE Sales, N.W. Center of Excellence, SL Pineros, HSR&D, N.W. Center of Excellence, H Sun, N.W. Center of Excellence, YF Li, N.W. Center of Excellence, AN Hedeen, N.W. Center of Excellence

Objectives: The benefits of lipid lowering therapy (LLT) with statins in patients with coronary heart disease (CHD) is associated with overall risk reductions of 22 to 34% for primary combined CHD endpoints. Existing clinical guidelines recommend LLT for patients with ischemic heart disease (IHD) who have LDL-C levels > 130 mg/dl. Still, a significant number of patients fail to receive guideline recommended therapy. The aim of this study was to (1) estimate the magnitude of non-compliance with the guideline recommendations in the VA system and, (2) describe patient characteristics associated with non-compliance.

Methods: As part of the Ischemic Heart Disease Quality Enhancement Research Initiative (IHD QUERI) we identified IHD patients who are actively seen in qualified primary care and specialty care clinics from the Veterans Integrated Services Network (VISN) 20 Data Warehouse. From this cohort we constructed a case-control study. Cases were patients who had an LDL-c > 130mg/dl and did not receive a lipid lowering drug (LLD) in 15 months prior to index date Dec31, 2000. Controls were patients who received a LLD, regardless of their LDL-c level.

Results: 471 patients were not in guideline compliance. Characteristics that were associated with a higher risk of not receiving  LLD were increasing age, high diastolic blood pressure, substance abuse, recent visit to mental health care provider, and number of qualified visits. Characteristics that reduced the risk of not having a LLD dispensed were: being a former smoker, obesity, diabetes, hypertension, having dispensed prescription for aspirin, beta-blockers and ACE inhibitors, and having visited a cardiologist in prior 15 months.

Conclusions: IHD VA male patients who are not in compliance with guideline recommended therapy have specific characteristics that differentiate them from other IHD patients.

Impact: Targeted quality improvement interventions are needed to assure that these patients receive quality care.