56 Optimising lipid treatment following myocardial infarction. (30th September 2020)

• Record Type: Journal Article
• Authors: Cartmill, C; Menown, I; Klabbers, G
• Is Part Of: Heart. Volume 106(2020)Supplement 4
• Page Start: A35
• Page End: A36
• Publication Date: 2020-09-30
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-ICS.56
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: European Society of Cardiology (ESC) guidelines recommend intensive control of LDL cholesterol (LDL-C) following myocardial infarction (MI) to improve outcome. Early assessment of lipids post MI is confounded by acute phase response requiring re-testing to guide need for up-titration ±additional treatment. Method: We studied patients admitted with MI across a healthcare region including 2 acute receiving hospitals over two years(2017–2018). Diagnosis, cardiovascular (CV) risk factors, CV history (Hx), lipid treatment before admission, lipid profile on admission, lipid treatment on discharge, lipid profiles at first and second follow up, changes to lipid treatment and readmission were recorded. Chi-squared was used to assess relationships between variables. Results: Of 638 acute MI admissions, 227(35.6%) had ST-elevation MI, 464(72.7%) were male, 174(27.3%) female. Baseline CV risk factors included diabetes 137(22.3%), family Hx 291(52.8%), smoking [current 188(30.9%); ex 164(26.9%)], CV Hx 359(58.1%). Lipid profile was tested on admission in 431(67.7%) subjects. For those already on lipid treatment, mean LDL-C was 2.22 mmol/l; for those not, mean was 2.91 mmol/l. Almost all (98.3%) were prescribed lipid lowering therapy prior to discharge (Atorvastatin 92.0%, Simvastatin 2.1%, Rosuvastatin 5.1%, Pravastatin 0.3%, Ezetimibe 0.5%). A high intensity statin was used in 94.4% of the sample. Mean time to first follow-up lipid profile was 5.65 months. Follow up profiles were available in 85.6%, in whom mean LDL-C was 1.67 mmol/l. At first follow up 349(54.7%) met the 2018 ESC target <1.8 mmol/l. For those not at target, 62(32.8%) received no further lipid testing and 13(6.9%) had therapy increased. At final lipid test, 62.7% achieved LDL-C <1.8 mmol/l. Males (p≤0.1) and diabetics (p = 0.01) were more likely to achieve target. Females were more likely to receive a lower dose of Atorvastatin (p = 0.004). There was no significant relationship between diabetes and discharge on higher intensity therapy (p > 0.05). Only 207 (37.9%) achieved the 2019 ESC target LDL-C<1.4 mmol/L. 36(6.6%) retained high LDL-C >3 mmol/L and 23(4.3%), very high LDL-C >3.5 mmol/L. Post discharge, 105(16.7%) received changes to lipid therapy; 32(5%) increased, 73(11.4%) decreased. A cardiac-related readmission occurred in 140(21.9%). Conclusion: In this large sample, baseline lipid profiles were available in only 2/3 patients and although follow up samples were available in 85.6%, the mean time for first follow up was double the recommended 3 months losing early opportunity for up-titration. Such follow up is of high clinical importance as, despite high use of intensive statin therapy, over 1/3 patients failed to achieve LDL-C <1.8 mmol/L. Fewer female patients were discharged on 80mg dose and were less likely to achieve target highlighting the importance of follow up in this group. At follow up only <5% met current NICE guidelines for use of PCSK9i yet 2/3 failed to achieve the current LDL-C target <1.4 mmol/L, suggesting a need for greater use Ezetimibe ± PCSK9i therapy.