Cardiovascular risk assessment and treatment to target low density lipoprotein levels in hospitalized ischemic heart disease patients: results of the HOLEM study

Hypercholesterolemia control status is lacking throughout the western world. To examine whether the treatment recommendations given to ischemic heart disease patients at hospital discharge are compatible with the guidelines of the Israeli medical societies and the U.S. National Cholesterol Education...

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Bibliographic Details
Published in:The Israel Medical Association journal 2005-06, Vol.7 (6), p.355-359
Main Authors: Harats, Dror, Leibovitz, Eyal, Maislos, Maximo, Wolfovitz, Efrat, Chajek-Shaul, Tova, Leitersdorf, Eran, Gavish, Dov, Gerber, Yariv, Goldbourt, Uri
Format: Article
Language:English
Subjects:
Arteriosclerosis - prevention & control
Cholesterol, LDL - blood
Education, Medical, Continuing
Female
Guideline Adherence
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypercholesterolemia - prevention & control
Israel
Logistic Models
Male
Middle Aged
Myocardial Infarction - prevention & control
Myocardial Ischemia - prevention & control
Patient Discharge - standards
Primary Health Care
Risk Assessment
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Summary:Hypercholesterolemia control status is lacking throughout the western world. To examine whether the treatment recommendations given to ischemic heart disease patients at hospital discharge are compatible with the guidelines of the Israeli medical societies and the U.S. National Cholesterol Education Program for coronary artery disease prevention; and to study the effects of brief educational sessions on the adherence of physicians with the guidelines. We included consecutive IHD patients admitted to four central hospitals in Israel between 1998 and 2000. The study was conducted in two phases. In phase 1, we reviewed discharge letters to document treatment recommendations given to each patient. In phase 2 we educated the practitioners by reviewing the Israeli medical societies and the NCEP guidelines and the quality of their recommendations in phase 1, after which we reevaluated the discharge letters. The study included 2,994 patients: 627 in phase 1 and 2,367 in phase 2. Of the patients who needed cholesterol-lowering according to their low density lipoprotein levels, 37.4% were not prescribed such drugs at discharge (under-treatment group). This proportion was reduced by education to 26.6% (P < 0.001) in phase 2. Of the treated patients, 65.6% did not reach the target LDLgoal in phase 1 (under-dosage group) as compared to 60.2% in phase 2 (P = 0.23). In phase 2 there was an increase in the percent of patients reaching LDL levels
ISSN:1565-1088