Abstract
Background: Targeting lower serum low-density lipoprotein cholesterol (LDL-C) levels has been a cornerstone for primary and secondary prevention of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, coronary revascularization, and cardiovascular death. The most recent cholesterol guidelines advise a target serum LDL-C level of <70 mg/dL using statins and other lipid-lowering agents in an escalating stepwise manner. The purpose of this quality improvement (QI) project is to encourage both physicians and patients to adhere to these new guidelines. Methods: This is a single-center QI project to be conducted at the Miami Veterans Affairs Medical Center (VAMC). When providers initiate or renew a prescription for a statin, a clinical reminder order check (CROC) will display within the electronic medical record (EMR) advising them that lipid guidelines now recommend high-intensity statin and/or additional agents as needed to target serum LDL-C level <70 mg/dL. This CROC will only be activated in the charts of patients with a history of cardiac ischemic event with or without revascularization and/or do not have a recent LDL-C on file within the past year and/or the most recent LDL-C is >70 mg/dL. Preliminary data from 6 months before and after CROC implementation will be collected and analyzed. The primary outcome of interest is statin prescription fill rate. Secondary outcomes include the number of patients with a serum LDL-C >70 mg/dL and 30-day mortality and readmissions rate for patients admitted for acute myocardial infarction (AMI). Results/Anticipated Results: Study enrollment and data collection is ongoing. For fiscal year 2019 (FY19), the national prescription fill rate for statins within the VA health system was 90.29% in patients with history of previous cardiac ischemic event. Regionally, prescription fill rate was 92.80%. The Miami VAMC prescription fill rate was 89.77% for FY19, and 83.78% in quarter 4. National and regional prescription fill rate in quarter 4 FY19 were 90.21% and 90.20%, respectively. The average 30-day mortality rate through quarter 3 of FY19 for the Miami VAMC for patients with a diagnosis of AMI was 7.17% (50th percentile, nationally = 7.60%). The average 30-day readmission rate after AMI during the same timeframe was 15.92% (50th percentile, nationally = 15.74%). Conclusion: Statins and other lipid lowering agents, targeting a serum LDL-C <70 mg/dL, have demonstrated to prevent secondary MACE in patients with a history of cardiac ischemia. By initiating this QI project to increase adherence to statins at the Miami VAMC, we expect an improvement in patient care reflected in relevant hospital quality metrics.
Published Version
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