Temporal Trends (1986-1997) in Cholesterol Assessment and Management Practices in Patients Hospitalized with Acute Myocardial Infarction: A Population-Based Perspective
Background: Elevated serum cholesterol levels are associated with increased risk of acute myocardial infarction (AMI) and adverse patient outcomes. It is unclear what proportion of patients have their serum cholesterol measured during hospitalization for AMI and are treated with lipid lowering therapy. The objectives of this longitudinal study were to examine trends over a decade long experience in serum cholesterol ordering practices during hospitalization for AMI and use of lipid lowering therapy. Methods: Observational study of 5204 residents of the Worcester, MA, metropolitan area hospitalized with validated AMI in all greater Worcester hospitals in seven one-year periods between 1986 and 1997. Results: Increases in the measurement of serum cholesterol levels during hospitalization for AMI were observed between 1986 and 1991 after which time there was a progressive decrease; only 24% of AMI patients in 1997 underwent cholesterol testing. Younger age, male sex, and absence of a history of cardiovascular disease were associated with an increased likelihood of serum cholesterol being measured. While the relative use of lipid lowering therapy increased significantly over time (0.4% in 1986; 10.7% in 1997), the absolute rate of utilization of lipid lowering therapy remained low. In patients with an elevated serum cholesterol (>240 mg/dL), 1.9% received lipid lowering therapy in 1986 and 36.6% in 1997. Conclusions: These findings suggest recent declines in the assessment of total cholesterol levels in patients hospitalized with AMI. While the use of lipid lowering therapy during hospitalization for AMI has increased over time, considerable room for improvement remains.