Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease

There is a lack of data evaluating the implementation of guidelines in the management of coronary artery disease (CAD) or congestive heart failure (CH F) in the outpatient setting. We analyzed an administrative data set from t he Merck & Co. sponsored national Quality Assurance Program, a retrospectiv e outpatient chart audit of 58,890 adult outpatients from 140 medical pract ices (80% cardiology only) in the USA with diagnoses of CAD and/or CHF iden tified from medical claims data. We determined the (1) frequency of lipid d ocumentation and prescription of lipid-lowering agents in patients with CAD , (2) frequency of assessment of left ventricular function and prescription of an angiotensin-converting enzyme inhibitor in patients with CHF, and (3 ) predictors of medication prescription. Of the 48,586 patients with CAD, 4 4% had annual diagnostic resting of low-density lipoprotein cholesterol. On ly 25% of these patients reached the target low-density lipoprotein cholest erol of less than or equal to 100 mg/dl, and only 39% were taking lipid-low ering therapy, which was less among the elderly than in the younger patient s. Of the 16,603 patients with CHF, 64% had diagnostic testing of left vent ricular function, and 50% of patients were taking an angiotensin-converting enzyme inhibitor; 67% of patients received medication if they had document ed systolic dysfunction. Significant predictors of medication prescription included diagnostic testing, younger age, history of myocardial infarction or coronary artery bypass grafting, hypertension, cardiology speciality, an d geographic region. Thus, current practice patterns in the management of C AD and CHF are inadequate. Patient age, diagnostic testing, and practice en vironment influence medication prescription. (C) 1999 by Excerpta Medica, I nc.