NCDR Study Points to Need For Improved Adherence to MI Prevention Strategies
Only 36 percent of patients who had a myocardial infarction (MI) were being treated for all of their risk factors, which include diabetes, previous cardiovascular disease and high cholesterol, according to a study published in the American Heart Journal.
The study, led by Andre R. M. Paixao, MD, FACC, of the Division of Cardiology, Emory University, Atlanta, GA, used data from the ACC’s ACTION Registry-GWTG, and examined records from 443,117 patients between January 2007 and November 2013. Risk factors assessed were Framingham Risk Score, diabetes without cardiovascular disease, a history of cardiovascular disease, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C).
When stratified by risk according to the Framingham Risk Score, 74,990 patients (17 percent) had a less than 10 percent chance of having an MI; 90,429 (20 percent) had between a 10 and 20 percent chance; and 25,710 (almost 6 percent) had more than a 20 percent chance. A total of 67,779 patients (15 percent) had diabetes without cardiovascular disease, and 184,218 (almost 42 percent) had a history of cardiovascular disease.
Results showed that each risk factor control metric was met in two-thirds of patients; but only 36 percent met all metrics. Further, overall statin eligibility prior to MI was 60.8 percent and 61.1 percent of statin-eligible patients reported statin use. Few individuals without diabetes or prior cardiovascular disease would be classified as high risk (13.4 percent); and many would not have met statin eligibility criteria prior to presentation with an acute MI.
In terms of LDL-C, 66 percent had elevated levels that did not meet recommended goals, and 29 percent met optional goals. For non-HDL-C, almost 67 percent of patients did not meet recommended goals, and 34 percent were below optional goals.
According to authors, their findings support implementing more aggressive treatment guidelines for cholesterol control medications. “The large proportion of MI patients not meeting risk factor control metrics observed in this study suggests the need for multilevel system-based interventions targeting patients, hospitals, and health care systems at the outpatient level,” they explain. Furthermore, “nationwide system-based interventions will likely be necessary to improve risk factor control,” they add.
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