Authors (including presenting author) :
Lai KPL, Chan PF, Chow KL, Chao DVK
Affiliation :
Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster
Introduction :
Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality. Optimizing the risk factors management including lipid modification is of utmost importance in secondary prevention of ASCVD events which are often more severe and debilitating.
Objectives :
1. To evaluate the factors leading to suboptimal lipid control of patients with ASCVD in a General Out-patient Clinic (GOPC) 2. To implement strategies for optimising lipid control and review the outcomes
Methodology :
The latest lipid profiles of patients with ASCVD attending the clinic from 1st February 2017 to 31st May 2017 (1st cycle) were retrieved. Medical records of patients with serum LDL-cholesterol level ≥1.8 mmol/L were reviewed for any identifiable factors leading to suboptimal lipid control. Interventions including introduction of new statin, promulgation of updated clinical guideline, conducting educational seminars, reminder setting, consultation skill training and regular review meetings with doctors were implemented. The latest lipid profiles of patients attending the clinic from 1st August 2019 to 30th November 2019 (2nd cycle) were then reviewed after the implementation of changes.
Result & Outcome :
941 and 1275 patients were included in the 1st and 2nd cycle respectively. For the 1st cycle, the mean age of the patients was 71.5 years old with more male patients (54.1%). The prevalence of ischaemic heart disease, stroke and peripheral vascular disease was 42.0%, 60.4% and 1.3% respectively. Among the 686 patients with LDL-cholesterol level ≥1.8 mmol/L in the 1st cycle, the top 5 factors leading to suboptimal lipid control identified were doctors’ unawareness of suboptimal lipid control (42.0%), poor diet control (38.9%), patients refused titration of lipid lowering drugs (14.3%), no lipid profile arranged by doctors after drug titration (5.6%) and intolerance to statin (2.3%). After the implementation of the interventions, the LDL-cholesterol control rate of < 1.8 mmol/L was significantly improved from 27.1% to 50.0% (p< 0.001). The mean LDL-cholesterol and triglycerides levels were also significantly improved from 2.16 mmol/L to 1.93 mmol/L and from 1.32 mmol/L to 1.22 mmol/L respectively (both with p< 0.001). Conclusion: A significant improvement of lipid control in patients with ASCVD could be achieved after a clinical audit in GOPC.
