Abstract 1189: Changing Trends (1986–2003) in the Assessment and Management of Hyperlipidemia in Patients with Acute Myocardial Infarction: A Community Based Perspective
Objective: To study nearly 2 decade long trends in the use of lipid lowering therapy (LLT) in patients with acute myocardial infarction (AMI) and to identify groups of patients in whom LLT was underutilized.
Background: Hyperlipidemia is recognized as a major modifiable risk factor for the development and progression of coronary heart disease. However, few studies have examined changing trends in the use of LLT in patients with AMI and clinical and demographic factors associated with the underutilization of LLT.
Methods: Trends in prescribing of LLT were assessed by reviewing the medical records of 9,249 greater Worcester (MA) residents who were hospitalized at all metropolitan Worcester medical centers in 10 biennial periods between 1986 and 2003 with independently validated AMI.
Results: The use of LLT increased from ≤ 1% in 1986 to 76% in 2003. New initiation of LLT in hospitalized patients who had not been on LLT previously increased from ≤ 1% in 1986 to 64% in 2003. Despite consistently increasing trends in the use of LLT in patients with various socio-demographic and clinical characteristics over time, LLT remained underutilized in elderly patients, women, those with a history of heart failure or stroke, those with an initial or Q wave MI, those with significant in hospital complications, and in patients who did not receive effective cardiac medications or undergo CABG and PCI. In patients with elevated total cholesterol levels on hospital admission (≥240mg/dl) and LDL (≥100mg/dl), use of LLT increased from 28% (1993/95) to 92% (2001/03).
Conclusion: The results of this community wide study in a large northeast metropolitan area suggest encouraging increases over time in the use of LLT in patients hospitalized with AMI. Despite these encouraging trends, several high risk patient groups remain suboptimally treated with this effective treatment regimen.