Undertreatment of hyperlipidemia in patients with coronary artery disease and heart failure☆☆☆
Received 5 June 2002; received in revised form 29 October 2002 and 31 October 2002
Abstract
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.
From the *Medical Review of North Carolina, Cary, North Carolina; †School of Medicine, University of North Carolina at Chapel Hill, North Carolina; and ‡School of Public Health, University of North Carolina at Chapel Hill, North Carolina
☆ Reprint requests: Carla A. Sueta, MD, PhD, Medical Review of North Carolina, 5625 Dillard Drive, Cary, NC 27511-9227.
☆☆ This analysis was funded by an unrestricted grant from Merck & Co., Inc. We wish to acknowledge and thank the many physicians and their staff who participated in the Merck-sponsored Quality Assurance Program.
ABSTRACT