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Non-attendance at secondary prevention clinics: the effect on lipid management
A L McLeod1, L Brooks, V Taylor
1Department of Cardiology, OPD3, New Royal Infirmary of Edinburgh at Little France, Edinburgh. a.mcleod@ed.ac.uk
Insights
Patients not attending secondary prevention clinics have poorer lipid management. Despite more cholesterol tests, non-attenders had higher total cholesterol levels, indicating a need for improved strategies for this coronary artery disease group.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Secondary prevention of coronary artery disease (CAD) is crucial for reducing morbidity and mortality.
- Effective lipid management is a cornerstone of secondary CAD prevention.
- Non-attendance to hospital-based secondary prevention clinics may compromise lipid control.
Purpose of the Study:
- To assess lipid management in patients with coronary artery disease (CAD) who did not attend a hospital-based secondary prevention clinic.
- To compare lipid profiles and treatment adherence between clinic attenders and non-attenders.
Main Methods:
- A 5-year retrospective study analyzing statin usage and total cholesterol levels.
- Data collected from patients with CAD following attendance at a cardiac nurse-led outpatient clinic.
- Lipid levels obtained from a central laboratory database for both discharged patients and non-attenders.
Main Results:
- 29% of patients defaulted from outpatient follow-up.
- Lipid-lowering drug usage was similar between attenders and non-attenders (72% vs. 74%).
- Clinic attenders were significantly more likely to achieve target total cholesterol levels (<5 mmol/L) at discharge (70% vs. 43%) and had lower mean cholesterol (4.75 vs. 5.33 mmol/L).
- Non-attenders had more cholesterol measurements but persistently inferior lipid profiles compared to attenders (61% vs. 78% at target, mean 4.85 vs. 4.52 mmol/L).
Conclusions:
- Patients defaulting from hospital follow-up exhibit higher total cholesterol levels and are less likely to reach target lipid goals.
- Despite increased monitoring, non-attenders demonstrate persistent lipid profile deficits compared to those completing follow-up.
- Enhanced implementation strategies are necessary to improve lipid management in patients who default from secondary prevention services.
Background:
Secondary prevention of coronary artery disease is effective in reducing morbitiy and mortality. Our aim was to assess lipid management following non-attendance to a hospital based secondary prevention clinic.
Methods:
Data were collected over 5 years on statin usage and total cholesterol levels for patients with coronary artery disease following attendance at a cardiac nurse led outpatient clinic. Lipid levels were taken from a central laboratory database, for both patients discharged from clinic and non-attenders.
Results:
From 935 inpatients discharged from hospital, 248 (29%) defaulted from outpatient follow up. Lipid lowering drug usage was similar (72% vs. 74% for non-attenders, p=NS). Attenders at the nurse led outpatient clinic were more likely to achieve a total cholesterol <5 mmol/L at discharge than non-attenders (70% vs. 43%; p < 0.001), with a lower mean total cholesterol (4.75 +/- 0.06 mmol/L vs. 5.33 +/- 0.08 mmol/L; p < 0.001). Non-attenders subsequently had a greater number of cholesterol measurements than those who were discharged from the hospital based clinic (range 0-12, c2 23.8 on 12 df p < 0.005). Lipid profiles in hospital non-attenders remained inferior with fewer achieving a total cholesterol <5 mmol/L (61% vs. 78%; p < 0.001), and having greater mean total cholesterol levels (4.85 +/- 0.06 mmol/L vs. 4.52 +/- 0.05 mmol/L; p < 0.001).
Conclusions:
Patients defaulting from hospital follow up have higher total cholesterols with fewer at target level compared to attenders. Though non-attenders receive subsequent lipid measurement, inferior lipid profiles persist compared to patients who completed hospital follow up to be discharged. Further implementation strategies are needed with regard to lipid management in this patient group.
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