Abstract P158: Lipid Management Challenges in Different Clinical Settings

Abstract

Background: Availability of lipid profile during a patient’s clinic encounter can improve decision-making in regards to therapy, and help achieve therapeutic goals. Methods: Encounters from 2 clinics run by one cardiologist; a University-based clinic and a Veterans Administration (VA) clinic were compared for availability of cholesterol profiles and level of cholesterol control in patients with coronary disease. Results: There were 93 out of 300 encounters (31%) with documented coronary disease (CAD) in the University clinic and 77 out of 134 encounters (57%) in the VA clinic. University patients with CAD had 61% (57/93) lipid documentation during their encounters, while VA patients had 99% (76/77) documentation. The average total cholesterol and LDL for University patients was 179 ± 42 mg/dL and 111 ± 35 mg/dL respectively, compared with 154 ± 38 mg/dL and 93 ± 35 mg/dL for the VA patients respectively (P < 0.01 for each category). Only 39% (22/57) of the University-based patients achieved LDL < 100 mg/dL, compared with 66% (51/77) of VA patients. Blood pressures, which were consistently documented every clinic visit in both clinics, averaged 128/76 mmHg in the University clinic compared with 131/75 mmHg in the VA clinic, with no statistically significant difference. Conclusion: Better control of cholesterol levels is seen in the VA-based clinic compared with the University-based clinic. This may partially be explained by the availability of laboratory results through a unified computer system, allowing more prompt decision-making with regards to medication changes and intensified dietary counseling during the clinic encounter. This may not be always available in other settings where laboratory tests are performed by a different provider utilizing a different reporting system which may not be readily shared or available to the treating cardiologist. Other factors could include variable compliance with laboratory appointments and access to medications. Our findings support establishing means for cardiologists to have access to patients’ laboratory results during their encounter to help more efficient decision making.