Study Suggests Redundant Lipid Testing in Veterans with CHD
Current performance measures in patients with coronary heart disease (CHD) suggest annual lipid testing followed by treatment intensification for those with abnormal lipids. However, the frequency of repeat lipid testing for CHD patients who have already attained guideline-recommended LDL-C treatment targets and receive no treatment intensification is unknown. Repeat lipid testing in these patients may represent overutilization and possibly waste of healthcare resources. This study sought to determine the frequency and correlates of repeat lipid testing in Veterans with CHD who had already attained the guideline-recommended LDL-C target of <100 mg/dL, and who received no treatment intensification. Using VA data, investigators identified 35,191 Veterans with CHD who received outpatient primary care in one VA network between 10/08 and 9/09. Investigators then assessed the proportion of these patients who had already attained guideline-recommended LDL-C levels but received repeat lipid testing in the 11 months following the index lipid test. Patient demographics and comorbidities, as well as number of primary care visits and medication adherence were examined, along with facility and provider characteristics. Investigators also assessed costs related to lipid testing.
- Of the 27,947 Veterans with CHD who had attained guideline-recommended LDL-C levels, one-third (n=9,200) had additional lipid testing performed without treatment intensification in the 11 months following their initial lipid panel.
- Collectively, these 9,200 patients had 12,686 additional lipid panels performed, with an annual extra cost of $203,990 for this VA network. This does not include the cost of the patients' time to undergo testing, or the providers' time to manage results and notify the patient.
- Veterans with concomitant diabetes, hypertension, and higher illness burden, and those who had more frequent primary care visits were more likely to undergo repeat lipid testing, while Veterans with good medication adherence were less likely to undergo repeat testing.
- Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62%) during 11 months of follow-up.
- These results pertain to only one VA network. In addition, some Veterans may have received part of their care outside VA, thus the true frequency of repeat lipid testing may have been underestimated.
- Data do not capture dietary or lifestyle recommendations. Therefore, it is possible that some repeat lipid testing in patients with LDL-C <100 mg/dL could have been performed following dietary or lifestyle recommendations by providers.
- These results highlight areas to target for future quality improvement initiatives aimed at reducing redundant lipid testing in patients with CHD.
Dr. Virani is supported by an HSR&D Career Development Award. Drs. Virani, Woodard, and Wang are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.
Virani S, Woodard L, Wang D, et al. Correlates of Repeat Lipid Testing in Patients with Coronary Heart Disease. JAMA Internal Medicine July 1, 2013;e-pub ahead of print.