Abstract 12931: Does Reporting Non-High-Density-Lipoprotein Cholesterol (Non-HDL-C) Levels on Standard Lipid Panel Improve Non-HDL-C Goal Attainment
Background: The Adult Treatment Panel (ATP) III guidelines established non-high-density-lipoprotein-cholesterol (non-HDL-C) as a secondary cholesterol treatment target. Non-HDL-C goal attainment remains poor in cardiovascular disease (CVD) patients and approximately 50% of the providers may not be able to calculate non-HDL-C (total cholesterol minus HDL-C). We determined whether simple reporting of non-HDL-C levels on standard lipid panels can improve non-HDL-C goal attainment.
Methods: We identified CVD patients receiving primary care within the Veterans Health Administration using International Classification of Diseases, 9th revision, diagnoses codes or current procedural terminology codes. Facility A (3,994 CVD patients) started reporting non-HDL-C levels on lipid panels beginning 9/9/08. To account for temporal trends in non-HDL-C goal attainment, we matched facility A to facility B of a similar size, patient complexity, and academic mission (4,269 CVD patients) that does not report non-HDL-C levels. Primary outcome was the difference in non-HDL-C levels from baseline to the most recent lipid panel for CVD patients seeking care at these facilities.
Results: Baseline non-HDL-C levels at facilities A and B were 114 mg/dl and 107 mg/dl, respectively. At 2.3 years of follow-up, mean non-HDL-C levels decreased at both facilities, but there was a greater decrease at the facility reporting non-HDL-C (facility A = -11 mg/dl versus facility B = -3 mg/dl, p <0.001). The results remained significant (p <0.001) after adjusting for patient's age, race, illness-burden, history of diabetes, hypertension, medication adherence, number of lipid panels, and number of primary care visits between baseline and follow-up. Greater reductions in non-HDL-C were seen among patients with triglycerides ≥ 200 mg/dl at baseline (-25 mg/dl at facility A versus -16 mg/dl at facility B, p=0.002 in adjusted models)
Conclusion: Direct non-HDL-C reporting could be an important implementation strategy to improve non-HDL-C goal attainment especially if non-HDL-C is retained as a treatment target in ATP IV guidelines. Future work should compare the effectiveness of different methods of improving compliance with cholesterol management guidelines for CVD patients.
- Cholesterol screening
- Quality of medical care
- Cardiovascular disease prevention
- Healthcare delivery systems
- © 2011 by American Heart Association, Inc.