BACKGROUND: Coronary artery disease patients with heart failure (CAD+HF) are at high risk for cardiovascular events. We examined the frequency of lipid assessment and prescription of lipid-lowering agents in outpatients with combined CAD+HF compared with patients with CAD alone. METHODS: We analyzed an administrative data set from the Quality Assurance Program II, a Merck & Co., Inc., sponsored national retrospective chart audit of 41,487 CAD patients seen at 296 ambulatory medical practices. About 34% of these patients had CAD+HF. RESULTS: Documentation of low-density lipoprotein (LDL) cholesterol was significantly lower in patients with CAD+HF (53%) compared with those with CAD alone (69%). Lipid-lowering drugs were prescribed in only 36% of patients with CAD+HF, compared with 52% of patients with CAD alone. Lipid levels alone did not justify this disparity. Patients with documented LDL cholesterol values were 4 times more likely to receive a prescription for a lipid-lowering medication than those without recorded values. Other predictors of lipid-lowering prescription included: younger age, history of myocardial infarction, revascularization, care by a cardiologist, and geographic region. CONCLUSIONS: Patients with CAD, HF, and advanced age simultaneously experience among the highest risk and the lowest lipid-lowering treatment rates. Strategies to increase LDL testing and aggressively treat patients with heart failure and CAD are warranted.
BACKGROUND:Coronary artery diseasepatients with heart failure (CAD+HF) are at high risk for cardiovascular events. We examined the frequency of lipid assessment and prescription of lipid-lowering agents in outpatients with combined CAD+HF compared with patients with CAD alone. METHODS: We analyzed an administrative data set from the Quality Assurance Program II, a Merck & Co., Inc., sponsored national retrospective chart audit of 41,487 CAD patients seen at 296 ambulatory medical practices. About 34% of these patients had CAD+HF. RESULTS: Documentation of low-density lipoprotein (LDL) cholesterol was significantly lower in patients with CAD+HF (53%) compared with those with CAD alone (69%). Lipid-lowering drugs were prescribed in only 36% of patients with CAD+HF, compared with 52% of patients with CAD alone. Lipid levels alone did not justify this disparity. Patients with documented LDL cholesterol values were 4 times more likely to receive a prescription for a lipid-lowering medication than those without recorded values. Other predictors of lipid-lowering prescription included: younger age, history of myocardial infarction, revascularization, care by a cardiologist, and geographic region. CONCLUSIONS:Patients with CAD, HF, and advanced age simultaneously experience among the highest risk and the lowest lipid-lowering treatment rates. Strategies to increase LDL testing and aggressively treat patients with heart failure and CAD are warranted.
Authors: Courtney R Lyles; Andrew J Karter; Bessie A Young; Clarence Spigner; David Grembowski; Dean Schillinger; Nancy Adler Journal: J Gen Intern Med Date: 2011-05-06 Impact factor: 5.128
Authors: Julie A Schmittdiel; Connie S Uratsu; Andrew J Karter; Michele Heisler; Usha Subramanian; Carol M Mangione; Joe V Selby Journal: J Gen Intern Med Date: 2008-03-04 Impact factor: 5.128
Authors: Joe V Selby; Julie A Schmittdiel; Bruce Fireman; Marc Jaffe; Laura J Ransom; Wendy Dyer; Connie S Uratsu; Mary E Reed; Eve A Kerr; John Hsu Journal: BMC Health Serv Res Date: 2012-07-02 Impact factor: 2.655
Authors: Mark W Massing; Kathleen A Foley; Lori Carter-Edwards; Carla A Sueta; Charles M Alexander; Ross J Simpson Journal: BMC Cardiovasc Disord Date: 2004-08-18 Impact factor: 2.298