FAILURE OF IMPLEMENTATION OF THE NATIONAL-HEART-FOUNDATION-OF-NEW-ZEALAND GUIDELINES FOR THE MANAGEMENT OF DYSLIPIDEMIA

Aims. We examined the outcome of patients at high absolute risk of cor onary events who had been discharged from the Green Lane Hospital risk factor clinic before publication of the 1993 National Heart Foundatio n of New Zealand (NHF) guidelines for management of dyslipidaemia. Met hods. Consecutive patients who had been discharged >12 months previous ly were followed up by general practitioner and patient questionnaires . Patients were categorised according to risk of a coronary event over 10 years. Ideal lipid levels (cholesterol <5.2 mmol/L, high-density l ipoprotein (HDL) cholesterol >1 mmol/L, total:HDL cholesterol ratio <5 ) and 'acceptable' lipid levels (cholesterol less than or equal to 6.5 mmol/L for high risk, less than or equal to 7.5 for moderate risk, <8 in men and <8.5 in women at mild or low risk) were defined according to the NHF guidelines. Results. Of the 270 patients, 55.6% were at ver y high risk, 25.5% at high risk, 10.4% at moderate risk, 3.8% at mild risk and 0.7% at low risk. Twenty-four percent of patients were manage d on diet alone at clinic discharge and 18% at follow up of 32+/-12 mo nths. Total cholesterol (6.39 mmol/L), HDL cholesterol (1.22 mmol/L) a nd the total:HDL cholesterol ratio (5.71) were unchanged from discharg e. In the very high risk. group ideal lipid levels were achieved in on ly 12% at discharge and 7% at follow up. The corresponding figures for achievement of acceptable lipids at discharge compared with follow up were 48% and 39% for the high risk group, 88% and 79% for the moderat e risk group and 93% and 93% for the mild risk group. The correspondin g figures for achievement of ideal lipids were 4% and 8% for the high risk group, 0% and 5% for the moderate risk group and 7% and 7% for th e mild risk group. Conclusions. Lipid levels achieved during clinic vi sits were maintained long term, but there were no improvements followi ng publication of the NHF guidelines. Continued efforts are needed to increase awareness and implementation of the guidelines, particularly in patients at high risk. Removal of the restrictions on prescription of lipid modifying agents by general practitioners and improved interc hange between general practitioners and specialists should greatly imp rove these outcomes.