Article Text
Abstract
Introduction Lowering LDL-C has been long proven to reduce progression of atherosclerosis and prevent future cardiac events in high-risk patients. For patients diagnosed with an AMI (acute myocardial infarct - STEMI & NSTEMI), ESC guidelines have consistently recommended high-intensity statin therapy to achieve a 50% reduction in LDL-C, or LDL-C levels of <1.4 mmol/L. Failure to do so should warrant consideration for Ezetimibe.Whilst statins are routinely initiated after an AMI diagnosis, this audit has evidenced that post-event lipid monitoring is substandard, and unachieved lipid lowering targets have been insufficiently addressed to facilitate further treatment in those who are otherwise eligible.
Purpose This audit, based on the 2019 ESC dyslipidaemia guidelines, outlines five criteria that we aim to achieve in patients admitted with an AMI:
1. A full lipid profile is measured at first presentation
2.Patient education on lifestyle modifications for secondary prevention of cardiovascular disease are delivered
3.Patients are started on a high-intensity statin (Atorvastatin 80 mg) before discharge
4.Repeat lipid profile& liver function tests are obtained at their first outpatient clinic appointment
5.Ezetimibe should be considered in addition to high-intensity statin for patients who have not reached the lipid reduction target (>50% LDL-C reduction from baseline, or LDL-C <1.4 mmolL) or as an alternative lipid-lowering therapy in patients intolerant to statins
Methods and Results After exclusion, a total of 203 inpatients at a district general hospital diagnosed with AMI from February 1st 2021 to September 31st 2021 were identified. Data was compiled from patient case records using clinical notes, a web-based laboratory reporting system, and healthcare summary records to assess relevant blood test results, ward round entries, and relevant correspondence including discharge and outpatient clinic letters.In the 8-month period, we have failed to achieve our >90% target threshold for any of the five criteria. 47% patients admitted with an AMI had lipid profiles taken on admission, and 72% had this retested at their follow-up outpatient review. 78% received lifestyle modification advice during admission, and high-intensity statin therapy was initiated for only 87%. For the 70 patients indicated for further lipid-lowering therapy with Ezetimibe, only 16% of them had received this recently licensed therapy.
Conclusion Dyslipidaemia is a leading reversible cause of cardiovascular morbidity and mortality, and opportunities to fully address this risk factor have not been consistently taken in secondary care. Ezetimibe has strong evidence on its efficacy in LDL reduction, hence strategies should be aimed at more effective identification of those who may benefit from this recently approved therapy. Cost-effective interventions such as educational presentations and poster information on relevant wards will be trialled with data collected to monitor the progress of each intervention as it is introduced.
Conflict of Interest None