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Cholesterol management in patients hospitalized for coronary heart disease
B O Boekeloo1, D M Becker, A LeBailly
1Johns Hopkins Medical Institutions, Preventive Cardiology Programs, Baltimore, Maryland.
Insights
Physicians rarely assessed or managed cholesterol in coronary heart disease (CHD) patients, despite evidence of benefit. Less than half believed cholesterol reduction lowers heart disease risk, indicating a need for improved physician training.
Area of Science:
- Cardiology
- Public Health
- Medical Education
Background:
- Coronary heart disease (CHD) patients exhibit high hypercholesterolemia rates.
- Lowering cholesterol levels offers significant benefits for CHD patients.
- Physician practices regarding cholesterol management in CHD require evaluation.
Purpose of the Study:
- To assess physician practice patterns and attitudes towards cholesterol assessment and management in hospitalized CHD patients.
- To identify gaps in care and physician confidence in cholesterol-lowering therapies.
Main Methods:
- Medical record audits of 154 CHD inpatients (aged <60) from 1983-1985.
- Physician survey administered in 1986 to 184 hospital staff physicians.
- Analysis of lipid profile orders, dietary interventions, and documentation of lipid abnormalities.
Main Results:
- Only 18% of CHD inpatients had lipid profiles ordered; 11% received low-fat diets.
- Lipid abnormality status was documented in 53% of patient records.
- Less than 50% of physicians believed cholesterol reduction lowers CHD risk; trainees showed less confidence than attending physicians.
Conclusions:
- Physician practices for cholesterol assessment and management in CHD patients were suboptimal and unchanged from 1983-1985.
- A significant portion of physicians lacked confidence in cholesterol-lowering therapies, highlighting educational deficits.
- Findings underscore the need for enhanced physician training in secondary prevention for CHD.
Abstract:
There is now substantial scientific evidence that patients with coronary heart disease (CHD) have a high prevalence of hypercholesterolemia and stand to benefit significantly from efforts to lower cholesterol levels. To evaluate physician practice patterns and attitudes concerning cholesterol assessment and management of patients hospitalized with an admitting diagnosis of CHD, one-month medical record audits were performed during 1983, 1984, and 1985, and a physician survey was administered in early 1986. Medical records of 154 inpatients hospitalized with a diagnosis of CHD before 60 years of age showed that, on the average, 18% had lipid profiles ordered and 11% received a low-fat diet in the hospital. The admission history and follow-up notes mentioned the presence or absence of lipid abnormalities in 53% of CHD inpatients. No significant changes occurred from 1983 to 1985. Survey results from 184 hospital staff physicians caring for these patients showed that less than half believed that a reduction in blood cholesterol lowers risk for heart disease in middle-aged patients with CHD. Interns and residents indicated less confidence in the efficacy of cholesterol-lowering diet and drug therapy than did attending physicians. The implications of these findings for physician training are discussed in light of recent studies of the efficacy of cholesterol lowering in secondary prevention.