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dc.contributor.authorMajumdar, Sumit R.
dc.contributor.authorGurwitz, Jerry H.
dc.contributor.authorSoumerai, Stephen B.
dc.date2022-08-11T08:09:25.000
dc.date.accessioned2022-08-23T16:29:51Z
dc.date.available2022-08-23T16:29:51Z
dc.date.issued1999-12-01
dc.date.submitted2009-09-29
dc.identifier.citationJ Gen Intern Med. 1999 December; 14(12): 711–717.
dc.identifier.issn0884-8734
dc.identifier.pmid10632815
dc.identifier.pmid10632815
dc.identifier.urihttp://hdl.handle.net/20.500.14038/37340
dc.description.abstractOBJECTIVES: To determine adherence to national guidelines for the secondary prevention of coronary artery disease (CAD) using lipid-lowering drugs (LLDs), by studying the rate of use of LLDs, predictors of use, and the rate of achieving lipid goals, among eligible patients recently hospitalized with acute myocardial infarction. DESIGN: Cross-sectional analysis of 2,938 medical records, collected from July 1995 to May 1996. SETTING: Thirty-seven community-based hospitals in Minnesota. PATIENTS: The 622 patients had previously established CAD and hyperlipidemia (total cholesterol> 200 mg/dL or currently using LLDs), and were eligible for LLDs according to the National Cholesterol Education Program II (NCEP II) Guidelines. MEASUREMENTS: The use of LLDs in eligible patients (primary outcome) and successful achievement of NCEP II goals (total cholesterol <160 mg>/dL) among treated patients (secondary outcome). MAIN RESULTS: Only 230 (37%) of 622 eligible patients received LLDs. In multivariate logistic regression, factors independently related to LLD use included age greater than 74 years (adjusted odds ratio [AOR] 0.55; 95% confidence interval [CI] 0.35, 0.88) and severe comorbidity (AOR 0.60; 95% CI 0.38, 0.95), managed care enrollee (AOR 1.56; 95% CI 1.02, 2.39), past smoker (AOR 1.72; 95% CI 0.98, 3.01), prior revascularization (AOR 2.31; 95% CI 1.51, 3.53), and the use of aspirin (AOR 1.59; 95% CI 1.07, 2.38) or >/=4 medications (AOR 2.89; 95% CI 2.19, 3.84). Of the treated patients who had lipid levels measured (n = 149), 15% achieved the recommended goal of a total cholesterol below 160 mg/dL. Of the untreated patients (n = 392), 89% were discharged from hospital without a LLD prescription. CONCLUSIONS: Lipid-lowering drugs, although proven effective for the secondary prevention of CAD, were used by only one third of eligible patients. Among patients receiving LLDs, few achieved recommended lipid goals. Directed quality improvement interventions, such as starting LLDs during hospitalization, may have the potential to substantially reduce CAD morbidity and mortality in this vulnerable population.
dc.language.isoen_US
dc.publisherBlackwell Publishing
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10632815&dopt=Abstract">Link to article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/ 10.1046/j.1525-1497.1999.02229.x.
dc.subjectAdult
dc.subjectAged
dc.subjectAntilipemic Agents
dc.subjectConfidence Intervals
dc.subjectCoronary Disease
dc.subjectCross-Sectional Studies
dc.subjectDrug Utilization
dc.subjectFemale
dc.subjectHumans
dc.subjectHyperlipidemias
dc.subjectLogistic Models
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectRetrospective Studies
dc.subjectRisk Assessment
dc.subjectSampling Studies
dc.subjectTreatment Outcome
dc.subjectHealth Services Research
dc.subjectMedicine and Health Sciences
dc.titleUndertreatment of hyperlipidemia in the secondary prevention of coronary artery disease.
dc.typeJournal Article
dc.source.journaltitleJournal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine
dc.source.volume14
dc.source.issue12
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/meyers_pp/96
dc.identifier.contextkey1019452
html.description.abstract<p>OBJECTIVES: To determine adherence to national guidelines for the secondary prevention of coronary artery disease (CAD) using lipid-lowering drugs (LLDs), by studying the rate of use of LLDs, predictors of use, and the rate of achieving lipid goals, among eligible patients recently hospitalized with acute myocardial infarction. DESIGN: Cross-sectional analysis of 2,938 medical records, collected from July 1995 to May 1996. SETTING: Thirty-seven community-based hospitals in Minnesota. PATIENTS: The 622 patients had previously established CAD and hyperlipidemia (total cholesterol> 200 mg/dL or currently using LLDs), and were eligible for LLDs according to the National Cholesterol Education Program II (NCEP II) Guidelines. MEASUREMENTS: The use of LLDs in eligible patients (primary outcome) and successful achievement of NCEP II goals (total cholesterol <160 mg>/dL) among treated patients (secondary outcome). MAIN RESULTS: Only 230 (37%) of 622 eligible patients received LLDs. In multivariate logistic regression, factors independently related to LLD use included age greater than 74 years (adjusted odds ratio [AOR] 0.55; 95% confidence interval [CI] 0.35, 0.88) and severe comorbidity (AOR 0.60; 95% CI 0.38, 0.95), managed care enrollee (AOR 1.56; 95% CI 1.02, 2.39), past smoker (AOR 1.72; 95% CI 0.98, 3.01), prior revascularization (AOR 2.31; 95% CI 1.51, 3.53), and the use of aspirin (AOR 1.59; 95% CI 1.07, 2.38) or >/=4 medications (AOR 2.89; 95% CI 2.19, 3.84). Of the treated patients who had lipid levels measured (n = 149), 15% achieved the recommended goal of a total cholesterol below 160 mg/dL. Of the untreated patients (n = 392), 89% were discharged from hospital without a LLD prescription. CONCLUSIONS: Lipid-lowering drugs, although proven effective for the secondary prevention of CAD, were used by only one third of eligible patients. Among patients receiving LLDs, few achieved recommended lipid goals. Directed quality improvement interventions, such as starting LLDs during hospitalization, may have the potential to substantially reduce CAD morbidity and mortality in this vulnerable population.</p>
dc.identifier.submissionpathmeyers_pp/96
dc.contributor.departmentDepartment of Medicine, Division of Geriatric Medicine
dc.contributor.departmentMeyers Primary Care Institute


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