Marked variability in reporting of low-density lipoprotein cholesterol values: a national review of pathology providers in Australia

Abstract Background/introduction Despite a plethora of evidence and guideline recommendations, fewer than 1 in 4 patients in Australia achieve their low-density lipoprotein cholesterol (LDL-C) goals. Gaps in clinicians’ knowledge of guidelines and patients’ awareness of their LDL-C targets likely contribute to implementation failure. While there is a central accreditation body for the provision of pathology in Australia, reporting formats are not regulated. Purpose We aimed to characterise and evaluate the variation in the reporting format of LDL-C among Australian pathology providers. Methods A cross-sectional national review was conducted through interviews and de-identified lipid panel reports from Australian public and private laboratories accredited by the Royal College of Pathologists of Australasia (covering 90% of pathology services in Australia). Data were extracted regarding LDL-C reference intervals, formatting practises, inclusion of interpretative comments with associated clinical management recommendations, and the supporting guidelines referenced. Results Fourteen of the fifteen pathology laboratories contacted provided data. Four were state-wide centralised public pathology networks, and three were national private pathology networks. Six different LDL-C upper reference limits were observed (range 2.0 - 3.7mmol/L, figure). Six laboratory networks emboldened abnormal LDL-C results, three highlighted the number in red, three flagged with varying asterisks and two did not highlight. Most laboratories did not provide individualised interpretative comments. Among the five laboratories which included recommendations for familial dyslipidaemia investigation, LDL-C cut-offs differed significantly (range 4.9–6.5mmol/L). LDL-C targets were notably inconsistent, likely in the setting of varying guidelines referenced; seven reports referenced the 2012 National Vascular Disease Prevention Alliance guideline and four referenced the 2001 National Heart Foundation guideline. Lipid targets and reference intervals remained disparate in the five laboratories which referenced the 2018 Australasian Association of Clinical Biochemists (AACB) Harmonisation guidelines. Conclusion The format and content of LDL-C reporting varies widely. Contrasting reference ranges and decision limits likely confuse both clinicians and patients as to what represents ‘normal’ and ‘target’. All referenced guidelines were outdated and superseded. Harmonisation of reporting may aid achievement of LDL-C goals.