Lipid control in patients with coronary heart disease treated in primary care or cardiology clinics

[Management of patients with dyslipidaemia in Spain. The Cardio Right Care Control of cardiovascular risk project]

OBJECTIVE

To ascertain the opinion of physicians about diagnostic criteria, control targets, control rates, and therapeutic approach of patients with dyslipidaemia in Spain.

METHODS

A specific questionnaire was created about diagnostic criteria, control targets, control rates, lipid lowering therapies, and therapeutic inertia in patients with dyslipidaemia. Physicians completed the questionnaire online during a 4-month period.

RESULTS

A total of 959 questionnaires were collected from all over Spain. The most frequent scale to stratify cardiovascular risk is SCORE (54.9%), and guidelines from the European Society of Cardiology are the most common guidelines used (50.5%). The majority of patients are on primary prevention (57.7%), and 31.4% have a high-very high cardiovascular risk. More than 70% of investigators considered that the target among patients at very high risk and those in secondary prevention is an LDL cholesterol < 70 mg/dL. It is considered by 60.0% and 66.4% of investigators that their patients on primary and secondary prevention, respectively, achieve control targets. Statins are the most common lipid lowering drugs used, followed by ezetimibe. In the majority of cases, when a patient is not adequately controlled with statins, there is an increase in the dose or a change to another statin. Poor adherence to treatment and therapeutic inertia are the main reasons for poor LDL cholesterol control.

CONCLUSIONS

The Cardio Right Care CVR Control project allows those aspects to be identified, as well as areas of improvement in patients with dyslipidaemia in Spain.

Physicians' behavior following changes in LDL cholesterol target goals

Background

In 01/2011 Clalit Health Services (CHS), changed the LDL-Cholesterol target definitions in its quality indicators program, from a universal target to values stratified by risk assessment based on ATP III criteria. The objective of this study is to evaluate the effect of this change on achievement of LDL-C targets and on physicians’ prescriptions of statins.

Study Design: A descriptive study based on administrative dataset 06/2010-06/2012.

Methods

Setting: CHS, The largest health maintenance organization in Israel that insures above 4,000,000 beneficiaries.

Patients: Patients who had been in the same risk group throughout the study period.

Measurements: Attainment of targets for LDL-C and purchases of statins prior to, and following, implementation of the guidelines in the CHS quality indicators program.

Results

433,662 patients remained in the same risk groups throughout the study period; 55.8% were women; the average age was 53.0 ± 10.3 years; 63.9%, 13.4%, and 22.7% were at low, medium, and high risk respectively. After implementation, the proportion of patients reaching LDL-C targets increased in all risk groups: from 58.6% to 61.6%, from 55.1% to 61.1%, and from 44.5% to 49.0%, in low, medium, and high risk groups respectively (p < 0.001). The proportion of patients treated with potent statins increased in all risk groups; from 3.4% to 5.6%, from 6.7% to 10.3%, and from 14.5% to 20.3% respectively (p < 0.001).

Conclusion

The risk stratification approach as a basis for the quality indicators program was implemented and better achievement of target LDL-C levels ensued. We suggest that implementation of quality indicators that are consistent with the current literature can lead to improvements that exceeds temporal trends.