Secondary prevention of hypercholesterolaemia: results of an audit conducted in South Wales.

Abstract

OBJECTIVE: To audit the standards of secondary prevention of coronary heart disease in postmyocardial infarction patients. DESIGN: Follow up audit, one year after acute admission with myocardial infarction. SETTING: University Hospital. SUBJECTS: For the initial admission, 153 patients were audited, with 84 patients contacted one year later. Demographic data, treatment status, and cholesterol levels were analysed both on admission and at follow up. INTERVENTIONS: Total cholesterol was checked at the audit time either in the hospital or in the doctor's surgery. MAIN OUTCOME MEASURES: Statin doses and cholesterol levels. RESULTS: Ninety six per cent of patients had their lipid profile performed on admission. Eighty three per cent of the patients with total cholesterol >/= 5 mmol/l were discharged from the hospital on lipid lowering medication. Forty five per cent of the subjects who were followed up had cholesterol levels >/= 5 mmol/l at 1 year. There was a disproportionate use of low doses of statins (lower than those shown in effective trials: simvastatin 20 to 40 mg, pravastatin 40 mg) with a third of all patients on medication not achieving the targets at one year. CONCLUSION: There was a major improvement in the proportion of patients started on treatment compared with figures reported by previous studies. However, the titration of the statin doses to achieve the targets is still unsatisfactory.