JMIR Publications

ABSTRACT

Background:

Clinical guidelines recommend lipid-lowering therapy for all patients with acute coronary syndromes (ACS). However, high-intensity statins have been underused for patients with ACS. We developed a new, pharmacist-initiated, team-based intervention to provide recommendations for guideline-directed statin therapy for hospitalized patients with ACS in this pilot study.

Objective:

This project had three objectives. The first was to improve the percentage of patients dismissed on optimal lipid lowering therapy following an ACS event. Second, we tested a new process for cardiovascular pharmacists to make direct recommendations regarding therapy and follow-up testing to the primary teams based on the patient's prior lipid lowering therapy and current LDL levels and lastly, we assessed how many of these patients had goal LDL levels at outpatient follow-up testing.

Methods:

Patients admitted with ACS to 6 cardiology hospital services at Mayo Clinic (Rochester, Minnesota) from August 1, 2021, to June 19, 2022, were assigned to the pharmacist-initiated, team-based intervention group or control group (stepped wedge cluster design). For the intervention group, pharmacists reviewed electronic health records and recommended changes in lipid therapy. For the control group, patients received usual care without the individualized pharmacist recommendations.

Results:

The study included 410 patients (69.5% men; median age, 68 years): 200 assigned to the control group and 210 to the intervention group. Lipid levels were measured for 83.8% of patients in the intervention group and 77.5% of patients in the control group (P=.14). Most of the 402 patients alive at discharge (88%) were discharged taking a high-intensity statin. Patients in the intervention group were more likely to have lipid-related recommendations in their discharge summary (26.3% vs 13.7%, P=.002). Of patients who survived to discharge, 41% had low-intensity lipoprotein (LDL) measured at follow-up; the median (IQR) LDL level was 63.5 (49-79) mg/dL; distributions were similar by group (P=.95).

Conclusions:

During hospitalization, excellent results were achieved for initiating high-intensity statin therapy. Lipid management recommendations were more frequently added to the discharge summaries of patients in the intervention group; however, less than 50% of patients with ACS underwent LDL measurements at follow-up, which represents an important opportunity to improve practice.