Abstract 15886: Pediatric Lipid Screening: Systematically Implementing the NHLBI Guidelines in a Primary Care Practice
Background: The 2011 NHLBI Integrated Guidelines for Pediatric Cardiovascular Health and Risk Reduction recommends lipid screening based on family history and medical risk factors, and universal age-based lipid screening. Despite the surrounding controversy, little is known about how these guidelines work in practice.
Methods: A Standardized Clinical Assessment and Management Plan (SCAMP) was used to implement the NHLBI lipid screening recommendations at well-child visits to the Boston Children’s Hospital Primary Care Center.
Results: There were 708 patients, mean age ± SD 11.4 ± 3.1 years, eligible for cholesterol screening between July 12, 2012 and March 20, 2013. The population was diverse: 31.4% Hispanic, 53.1% Black non-Hispanic. Many had concerning family histories of early MI or stroke (13.3%), or hyperlipidemia (29.5%); half were obese/overweight (50.2%), and 2.1% had a high risk medical diagnosis such as diabetes. A third qualified for lipid screening based on age alone (36.3%).
Primary care providers (PCPs) recommended cholesterol screening to 671 (95%) patients; 164 (23%) skipped labs despite the PCP recommendation. Children who did and did not obtain labs were similar with regard to age, sex, race/ethnicity and BMI.
Testing was performed primarily non-fasting (94.7%). An abnormal screen was defined as non-HDL >120 mg/dL. Results were abnormal in 106 patients (20.9%), and were more common in those with selective indications compared to age-based screening (25.8% vs. 11.8%, p<0.001). No patients met SCAMP criteria for immediate subspecialty referral (non-HDL cholesterol >280 mg/dL), although 2 patients subsequently had LDL levels that may require pharmacotherapy (168 and 173 mg/dL). Initial management included diet changes (86.8%), fasting lipid testing (68.9%), weight loss (27.4%), and exercise (20.8%); only 12.3% were referred to a dietician despite NHLBI Guideline recommendations and no patients were prescribed medication for high cholesterol.
Conclusion: Given less than optimal patient adherence, rare significantly abnormal results, and low rates of abnormalities in age-based screening, more research is needed to understand barriers and facilitators, benefits and harms to lipid screening in pediatric primary care.
- © 2013 by American Heart Association, Inc.