1. Unnecessary Lipid Screening of Inpatient Admissions Dennis Whang 4/2/12 DSR2

2. Lipid Disorders Mean worldwide age-standardized total cholesterol is 179 mg/dl for men, 184 mg/dl for women US adults: 16% have total cholesterol > 240 mg/dl Coronary heart disease events related to dyslipidemia – Dyslipidemia is associated with 80-88% of premature CHD events compared to 40-48% in age-matched controls without coronary disease – Middle aged men with TC > 230 mg/dl have 10% risk of coronary death before age 65 compared to men with TC < 170 mg/dl who have 3% risk Primary prevention of coronary events – West of Scotland Study: 31% decrease in MI, 22% decrease in mortality in middle-aged men with pravastatin compared with placebo Meta-analysis of primary prevention trials: statins reduce overall mortality (RR 0.83, [0.73 to 0.95]) and fatal and non-fatal cardiovascular disease events (RR 0.70, 95% CI 0.61 to 0.79) – Taylor F, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2011

3. Lipid Screening Guidelines NCEP/ATPIII recommend screening all adults age 20 and over every 5 years USPSTF Screening Guidelines – Men aged 35 and older (A) – Women aged 45 and older if at higher risk for coronary artery disease (CAD) (A) – If at higher risk for CAD, start screening age 20 (B) – Screening intervals are uncertain, but every 5 years is recommended.

4. Lipid Screening As Inpatient No guideline regarding screening inpatients for primary prevention Utility of screening Management of dyslipidemia Who will follow-up Excess cost as inpatient – Lipid panel $20-$91

5. Study of Inpatient Evaluate use of lipid screening of Team *** Admissions dated 3/25/12-3/31/12 Analyzed: – Number of lipid screens – Indication of lipid screen – Management changes

6. Lipid Screening as Inpatient Number of patients admitted 31 Number of lipid panels ordered: 10 Prior dx of dyslipidemia: 12 (39%) – 8 did not receive repeat lipid panel – 4 checked with lipid panel 1 patient statin was increased for possible ACS 6 lipid panels were ordered with no prior dx – None were indicated, associated with admission dx – 1 patient was started on statin for prior history of CAD

7. Conclusions Majority of patients with HL (66%) did not receive repeat lipid panel – Medicine teams continue to order lipid panels which are not indicated 1 of 10 ordered lipid panels associated with management of admission dx (chest pain) – 9 extra lipid panels ordered  extra cost of $360 Lack of management changes after lipid panels being checked Assessing unnecessary ordering of daily labs and lipid panels could potentially improve cost conscious care