(Circulation. 2007;116:II_846.)
© 2007 American Heart Association, Inc.
Modifying Risks and Risks of Intervention |
Abstract 3724: A One-Step Statin Titration Process Moves Large Numbers of Patients to LDL-C Goal
Southern California Kaiser Permanente, Harbor City, CA
Introduction. Although compelling evidence supports the concept that people at high CVD risk should have LDL-C < 100, a substantial number of them have levels > 99 even though on statin treatment. This has been attributed to inadequate or absent medication titration. This project’s purpose is to lower LDL-C in a large population of high risk people by a centralized pharmacy-mediated medication efficacy increase process that involves minimal physician time.
Methods. Diabetes or CVD patients on a statin and with an LDL > 99 were selected (N > 3000). Because by design there was minimal physician or pharmacist contact with patients, for safety extensive exclusion criteria were applied. Prescribing physicians were asked via a web-based "eApproval" message to approve or disapprove each patient’s inclusion in the project. Pharmacists increased approved patients’ statin efficacy via a titration algorithm designed to lower LDL-C to < 100 in 1 step. Patients were informed by automated phone message and letter that their next medication refill would be a higher dose or stronger medication and advised to perform follow-up lab.
Results. Most (88%) panel-carrying physicians responded to the eApproval request, approving 92% of their patients. In 6 days, 2 pharmacists increased the medication efficacy for 787 patients. At an average of 52 days (range 1–153) after titration, 75% of patients had filled their new prescription and 62% of those had done a subsequent LDL-C test. LDL-C was reduced by 27 from a baseline mean of 118 to a post-titration mean of 91 mg/dL, a 23% reduction. LDL-C < 100 mg/dL was achieved by 71% of patients. Patients of physicians who did not respond to the eApproval request (N = 110) lowered their mean LDL-C from 123.7 to 119.4, a 3.5% reduction and12.7% of these "usual care" patients attained an LDL-C < 100.
Conclusions:
- A large number of high risk patients are on inadequate statin therapy.
- A sizeable percentage of this population can be brought to LDL-C goal by a 1-step, pharmacy-mediated intervention that requires minimal physician involvement.
- The medication titration algorithm is effective in reducing LDL-C the expected amount.
- Widespread implementation of this process would be expected to prevent a substantial amount of CVD morbidity and mortality.
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