Brief Introduction The importance of conducting lipid profiles on admission is highlighted by NICE (National Institute of Clinical Excellence). There is specific guidance on the handling of lipid profiles of NSTEMI (non S-T elevation Myocardial infarction) and Tropinin negative ACS (acute coronary syndrome) patients (CG181). Within a busy East London district general hospital, we examined how effectively this was being undertaken.
Explanation of basic Methods We conducted a retrospective study of 90 patients; NSTEMI/ Tropinin negative ACS admitted between July 2014 and May 2015. (Age: 44–97 mean: 70.5). 77% of patients had commodities which included diabetes, hypertension or a previous history of hypercholesterolemia. We extracted key data from individual patient notes, contacted General Practices and searched the database of patients available at Newham university hospital. This included lipid profiles; whether they were done on admission, the cholesterol level and whether a 3 month lipid profile was done before or after admission. We also recorded the statin type patients were commenced on or changed to. Each individual case was compared to the NICE guidelines on lipid handling in secondary prevention in NSTEMI and tropinin negative ACS patients.
Results Overall 67% of patients (age: 44–97 mean: 70.5) who, according to the guidelines, should have had a lipid profile check on admission had not. 80% did not have their lipid profile checked after 3 months. Of those that did have a lipid profile on admission, 40% had a cholesterol level >4.68% patients already on a statin were switched to atorvastatin 80 mg as in accordance to the NICE guidelines. Of those known, 72% were started on a statin. Of those 72%, 85% were commenced on artorvastatin 80mg.
Conclusions/Implications This shows that although we are good at putting patients admitted with NSTEMI/Tropinin negative ACS on atorvastatin 80mg (as in accordance to the NICE guidelines), we do not take into consideration their current lipid level on admission nor do we consider their 3 month post admission lipid profile. This situation makes it impossible to calculate whether the target of a fall of 40% in non-HDL cholesterol is reached after 3 months on statin therapy and significantly limits our knowledge on the patients condition. Moreover, 77% of the examined patients had co-morbidities such as diabetes or hypertension and of these only 45% had a 3 month follow up lipid profile. This collectively demonstrates a lack of understanding of the importance of conducting a lipid profile on admission or 3 months after admission although clearly stated in the NICE guidelines.
- Lipid profile
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