Key result
Canadian survey reveals significant post-ACS lipid management variation, with ~68% routinely obtaining 24-hour lipid panels.
Why the study?
Significant variability exists in the application of therapies to lower LDL cholesterol levels in clinical practice following an ACS event.
What are the practice patterns and knowledge gaps among Canadian specialists regarding lipid management following an acute coronary syndrome event?
Cross-Sectional (n=200)
Yes
What are the practice patterns and knowledge gaps among Canadian specialists regarding lipid management following an acute coronary syndrome event?
There is significant variation in practice patterns and suboptimal achievement of guideline-recommended LDL cholesterol levels among Canadian specialists managing post-ACS patients.
Practice variation in post-ACS lipid management persists among specialists; supports standardized protocols and further research on optimal testing.
BACKGROUND: Following the occurrence of an acute coronary syndrome (ACS), patients are at high risk for subsequent cardiovascular events. Therapies to lower the level of low-density lipoprotein (LDL) cholesterol remain a pillar in secondary prevention approaches following ACS. Significant variability remains in the application of therapies to lower cholesterol level in clinical practice. METHODS: A cross-sectional, online survey was conducted of 200 cardiovascular and lipid specialists across Canada who routinely care for patients following the occurrence of ACSs. The survey consisted of 50 multiple-choice questions with opportunities for free-text entry exploring knowledge of lipid guidelines and recent clinical trials, and in-hospital and outpatient management of lipids and familial hypercholesterolemia. RESULTS: A total of 67.5% (n = 135) of participants stated that a lipid panel would routinely be obtained during the first 24 hours of an admission for an ACS, and 68.5% (n = 137) stated that their hospitals had standing orders for statin initiation at ACS presentation. In high-risk patients, the majority (75.5%; n = 151) of participants indicated that they target an LDL cholesterol level of <1.8 mmol/L. However, a subset (22%; n = 44) would target lower LDL cholesterol levels ranging from 0.5 to 1.7 mmol/L. Only 32.0% (n = 64) of participants stated that >70% of their ACS patients were at or below guideline-recommended LDL cholesterol levels. Respondents generally underappreciated the prevalence of familial hypercholesterolemia in both the general population and ACS patients. CONCLUSIONS: There is significant variation in practice patterns involving therapies to lower LDL cholesterol level in the post-ACS onset period. To improve management of lipids in this high-risk population, changes to institutional policies, shared responsibility of lipid management across multiple disciplines, and physician education are required.
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Gouda et al. (2020) conducted a cross-sectional in Lipid management following acute coronary syndrome (n=200). Lipid management practices was evaluated on Routine lipid panel obtained during the first 24 hours of an admission for an ACS. A survey of 200 Canadian specialists revealed significant variation in post-ACS lipid management, with 67.5% routinely obtaining a lipid panel within 24 hours of admission.
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