Improving lipid evaluation and management in Medicare patients hospitalized for acute myocardial infarction

Background: The control of low-density lipoprotein cholesterol (LDL-C) leve ls in patients with known coronary artery disease, particularly in those wi th acute myocardial infarction, has been shown to reduce the rates of disea se progression, recurrent events, and mortality. Objectives: To evaluate and improve hospital-based processes for measuring and treating, when necessary, LDL-C levels above 3.36 mmol/L(>130 mg/dL) in patients with an acute myocardial infarction Design: A nonrandomized retrospective baseline study followed by a collabor ative educational intervention with participating hospitals and a second no nrandomized postintervention study. Patients: Four hundred six preintervention patients discharged from the hos pital alive after a confirmed acute myocardial infarction in 1996, and 498 postintervention patients discharged from the hospital in 1999. Interventions: performance of lipid profiles on admission to the hospital a nd during hospitalization and drug and dietary interventions. Results: The measurement of LDL-C level on admission to the hospital increa sed from 8% preintervention in 1996 to 32% postintervention in 1999. The me asurement during hospitalization increased from 14% preintervention to 48% postintervention. Hospitals that initiated programs to ensure early lipid e valuations through preprinted orders and policy changes achieved an average patient LDL-C measurement rate of 70% in 1999. Hospitals lacking standard policies averaged only 23% at the same time. Of the patients with a measure d LDL-C level greater than 3.35 mmol/L (>130 mg/dL) who were not undergoing drug therapy on admission to the hospital, 46% were given lipid-lowering a gents by discharge from the hospital during the postintervention period. Du ring this same period, only 11% of the patients were prescribed this therap y if they had either a lower measured level or no LDL-C measurement at all. Conclusion: Active hospital-based programs to ensure routine LDL-C measurem ents in patients admitted for acute myocardial infarction increased the use of appropriate lipid-lowering therapy in these high-risk individuals and c ould contribute to reducing the incidence of recurrent coronary artery dise ase.