LDL goal achievement in 766 consecutive, unselected coronary heart disease patients, a comparison between usual care and a structured follow-up program in out of hospital cardiology practice

Abstract

Purpose: Lipid level goal achievement by Guidelines (LDL≤2.0 and cholesterol ≤ 4 mmol/L) is generally low in high risk patients, including those with angiographically documented coronary heart disease (CHD). We evaluated the effect of a Structured Follow-Up (SFU) program in cardiology practice; compared to Conventional Follow-Up in general practice after one cardiologist consultation (CFU), in consecutive CHD patients remitted from primary care to a cardiology practice outside hospital. Methods: All patients from 2010 (CFU) were retrospectively reviewed, and follow-up lipid levels were collected from the general practitioners. All patients from 2011 and 2012 were prospectively followed in the cardiology practice until LDL goals were achieved, or further trials considered futile for lack of effect, side effects or for administrative reasons. As needed, statins (simvastatin, atorvastatin or rosuvastatin) were started, dosages increased, more potent statins prescribed and ezetimib added. Results: The 2010 and 2011-12 cohorts were similar for all baseline variables. Only 1/3 of patients had LDL levels according to guidelines when remitted, after the SFU program this increased to 89%, compared to only 59% after CFU. LDL goals were not reached for insufficient drug effects (n-13), side effects or contraindications (n-14), administrative reasons (n-16), and still being in FU (n-11). View this table: Conclusions: A simple, structured FU program, using only three different statins with the addition of ezetimib when needed, can bring 89% to reach the recommended LDL levels, clearly superior to the results of CFU. The recommendation by Guidelines that the cardiologist only should be an advisor to the general practitioner (CFU) may be questioned.