Lipid-lowering therapy following major cardiac events: progress and deficits

Objective: To assess hospital prescribing of lipid-lowering agents in a ter tiary hospital, and examine continuation of, or changes to, such therapy in the 6-18 months following discharge. Design: Retrospective data extraction from the hospital records of patients admitted from October 1998 to April 1999. These patients and their general practitioners were then contacted to obtain information about ongoing mana gement after discharge. Setting: Tertiary public hospital and community. Participants: 352 patients admitted to hospital with acute myocardial infar ction or unstable angina, and their GPs. Main outcome measures: Percentage of eligible patients discharged on lipid- lowering therapy and percentage of patients continuing or starting such the rapy 6-18 months after discharge. Results: 10% of inpatients with acute coronary syndromes did not have lipid -level estimations performed or arranged during admission. Documentation of lipid levels in discharge summaries was poor. Eighteen per cent of patient s with a total serum cholesterol level greater than 5.5 mmol/L did not rece ive a discharge prescription for a cholesterol-lowering agent. Compliance w ith treatment on follow-up was 88% in the group discharged on treatment. Ho wever, at follow-up, 70% of patients discharged without therapy had not bee n commenced on lipid-lowering treatment by their GPs. Conclusions: Prescribing of lipid-lowering therapy for secondary prevention following acute coronary syndromes remains suboptimal. Commencing treatmen t in hospital is likely to result in continuing therapy in the community. B etter communication of lipid-level results, treatment and treatment aims be tween hospitals and GPs might encourage optimal treatment practices.