Asian Journal of Internal Medicine (Feb 2023)

Audit on lipid screening, management and target achievement in prevention of cardiovascular disease in patients attending a medical clinic in National Hospital Kandy: Are we on par with the guidelines?

  • F. N. Nasim,
  • M. Jazeema,
  • F. Fasrina,
  • S. Bowattage,
  • W. K. S. Kularatne

DOI
https://doi.org/10.4038/ajim.v2i1.69
Journal volume & issue
Vol. 2, no. 1

Abstract

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Background: Cardiovascular disease (CVD) remains a major cause of morbidity and mortality in Sri Lanka. 2019 European Society of Cardiology (ESC) guidelines recommend risk stratification based on co- morbidities, lipid profiles, standardized scoring and prescription of statins to achieve set lipid targets, to reduce CVD. Nevertheless implementation of guidance remains variable. The objective of this study was to identify the gaps in clinical practice and adherence to ESC guidelines in the management of dyslipidaemia. Methods: All patients attending a routine internal medical clinic were assessed retrospectively. Their comorbidities, level of risk, current therapy, cholesterol monitoring, and response to LDL-C targets were noted and compared with guideline based audit standards. Results: Out of 114 patients (69 female) with a mean age (±SD) of 63.98 (±11.5) years, 39 (34.2%) had CVD, 18 (15.8%) strokes, 70 (61.4%) hypertension and 63 ( 43.8 %) type 2 diabetes mellitus. Only 55.3% of patients had a single lipid profile and 39.7% a subsequent measurement. While 56.4% of CVD and 38.8% of stroke patients were on moderate intensity statins, 38.4% of CVD and 44.4% of stroke patients were on high intensity statins. Despite lack of contraindications 5.1% of CVD and 16.6%of stroke patients were not on satins. Of the patients with diabetes, 22%were not on statins and 68% were on low or moderate intensity statins. Lipid targets were achieved in 23.8% of the patients with diabetes. Targets were not checked in the majority. Of the 56% who didn’t achieve targets only 41.1% received drug optimisation. Conclusions: Lipid screening and treatment targets remain suboptimal despite set guideline standards. Dissemination of guideline recommendations and motivation to reduce physician inertia is mandatory in preventing cardiovascular disease.

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