The Use of Lipid-Lowering Drugs after MI-Yet Another Opportunity to Improve Care
Volume XI, Issue 1
Harold J. DeMonaco, M.S. Director of Drug Therapy Management

Previous reports in the literature have suggested a relative failure on the part of clinicians to provide patients with optimal care at the time of discharge from the hospital. Numerous studies have documented the failure of the healthcare delivery system to provide angiotensin-converting enzyme inhibitors to patients at discharge after admission for congestive heart failure and beta-blockers at the time of discharge after admission for a myocardial infarction, with even the best hospitals in the country only able to achieve a 70-75% compliance rate.1,2,3

A recent report from the National Registry for Myocardial Infarction 3 suggests a consistent failure to provide lipid-lowering therapy at the time of discharge after myocardial infarction.4 The report, in Circulation, documents the discharge management of 138,001 patients from 1470 participating hospitals from July 1998 to June 1999. On average, 31.7% of patients discharged after myocardial infarction received lipid-lowering therapy. Multivariate analysis of the data suggests a history of hypercholesterolemia, cardiac catheterization during the hospitalization, care provided at the teaching hospital, concurrent use of a beta-blocker and counseling for smoking cessation all correlated with lipid-lowering therapy prescription. Lipid-lowering drugs were given less frequently in the elderly (age 65-74 years as compared to those less than 55 years), and those with a history of hypertension and coronary artery bypass surgery, despite overwhelming evidence that aggressive lipid lowering reduces subsequent events even in the elderly patient.

Lipid lowering is one of the most cost-effective therapies available, especially in secondary prevention patients. Clinicians are urged to consider lipid-lowering drugs early during the hospital course of patients with myocardial infarction.

References:
  1. Nohria A, Chen YT, Morton DJ et al. Quality of care for patients hospitalized with heart failure at academic medical centers. Am Heart J. 1999: 137(6); 1028-34.
  2. Dwamena FC, El-Tamimi H, Watson RE et al. The use of angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction in community hospitals. Clin Cardiol 2000: 23(5); 341-6.
  3. Chen J, Radford MJ, Wang Y et al. Do "America's Best Hospitals" perform better for acute myocardial infarction? N Engl J Med. 1999: 340(4); 286-92.

Fonarow GC, French WJ, Parsons LS et al. Use of lipid-lowering medications at discharge in patients with acute myocardial infarction. Circulation. 2001: 103 (1); 38-44. Available on line: http://circ.ahajournals.org/cgi/content/full/103/1/38#T4.