Secondary prevention in a cardiology group practice and hospital setting after a heart-care initiative

• Published in: The American journal of cardiology 2000-02, Vol.85 (3), p.23-29
• Main Authors: LaBresh, Kenneth A, Owen, Patricia, Alteri, Catherine, Reilly, Susan, Albright, Patricia Shea, Hordes, Andrew R, Shaftel, Peter A, Noonan, Thomas E, Stoukides, Cheryl A, Kaul, Alan F
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology - methods; Cardiovascular disease; Cholesterol; Cholesterol, LDL - blood; Coronary Disease - blood; Coronary Disease - etiology; Coronary Disease - prevention & control; Female; General and cellular metabolism. Vitamins; Group Practice; Health care; Health Education; Hospitals, University; Humans; Hyperlipidemias - blood; Hyperlipidemias - complications; Hyperlipidemias - drug therapy; Hypolipidemic Agents - therapeutic use; Inpatients; Male; Medical sciences; Outpatients; Pharmacology. Drug treatments; Practice Patterns, Physicians; Retrospective Studies
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)00935-2

The American Heart Association (AHA) Consensus Panel Statement for Preventing Heart Attack and Death in Patients with Coronary Disease provides recommendations for the secondary prevention of heart disease in at-risk patients. Blackstone Cardiology Associates of Pawtucket, Rhode Island, undertook an initiative in their practice implementing secondary-prevention guidelines in patients with coronary artery disease. This retrospective study evaluates practice patterns for the management of hyperlipidemia for a cardiology group in an ambulatory and hospital setting after the institution of a physician-supervised, nurse-based disease management program. Practice patterns in patients with established coronary heart disease treated in a lipid center compared with non–lipid-center settings were evaluated. Parameters evaluated included documenting low-density lipoprotein (LDL) cholesterol, presence of lipid-lowering therapy, and achieving the National Cholesterol Education Program II (NCEP II) goal of LDL-cholesterol levels ≤100 mg/dL in patients with preexisting coronary artery disease. A total of 352 patients met inclusion criteria in the lipid-center setting and were compared with 289 non–lipid-center consecutively chosen patients. Age and gender differences were also evaluated. Inpatient medical records from a 254-bed Brown University–affiliated teaching hospital were also evaluated for lipid profile, achievement of NCEP II goal, and use of lipid-lowering medication on admission and discharge. The most recent LDL-cholesterol values of patients followed in the lipid-center and in the non–lipid-center setting of the Blackstone Cardiology Associates were compared. Blackstone Cardiology Associates consists of 4 cardiologists and 4 advanced-practice nurses. Achievement of LDL-cholesterol goal was higher in both the lipid-center and non–lipid-center settings compared with baseline. A smaller percentage of patients at goal in the lipid setting is likely due to referral bias resulting in patients with more difficult-to-manage mixed dyslipidemias and behavior-management issues ending up in the lipid center. There were no apparent sex differences at goal, and more elderly (age ≥65 years) achieved goal in the lipid clinic center. In the non–lipid-center setting, more males were at goal and had a lower mean LDL-cholesterol level.