Intensive surveillance and treatment of dyslipidemia in the postinfarct patient: Evaluation of a nurse-oriented management approach

BACKGROUND: Lowering plasma low density lipoprotein (LDL) cholesterol conce ntrations in patients with established coronary artery disease is essential if recurrent cardiac events and mortality are to be prevented; however, a large proportion of patients with myocardial infarction (MI) are not screen ed and treated appropriately in the months immediately following hospital d ischarge. OBJECTIVES AND METHODS: The CHOlesterol Post-INfarct (CHOPIN) project is a nurse centred program initiated to close the large gap between nationally c entred recognized guidelines for LDL lowering and current actual practice i n the secondary prevention of coronary artery disease. RESULTS: The authors report findings in 151 consecutive patients (70 years of age or less) followed for an average of 5.5+/-3.3 months. Three months a fter an index MI and at a time when patients started being followed in CHOP IN, 46% of patients had LDL in excess of 2.5 mmol/L and 36% had LDL greater than 3.20 mmol/L. LDL lowering interventions under taken comprised either consultation with a dietitian (35%) or initiation or modification of lipid lowering medication (58%). Mean LDL on discharge from CHOPIN was 2.58+/-0.4 9 mmol/L, and 97% of the patients had LDL cholesterol less than 3.20 mmol/L at discharge. CONCLUSIONS: This experience shows that a nurse based case management strat egy can achieve good control of dyslipidemia in a large proportion of post- MI patients. Because intervention to lower LDL has been prospectively shown to reduce the need for coronary artery bypass and angioplasty, these resul ts suggest that projects configured in the manner of CHOPIN should reduce h ospital costs associated with cardio vascular disease.