Repeat Lipid Testing in Patients with Coronary Heart Disease
Based on Adult Treatment Panel III guidelines, it is common current practice to suggest annual lipid testing in patients with coronary heart disease (CHD). Those with abnormal lipid levels are suggested to receive intensified treatment. For those without abnormal lipid levels who continue to have annual lipid testing, it is possible that in these patients, repeat lipid testing may represent health resource overuse and the possible waste of healthcare resources.
The goal of the analysis was to determine the frequency and correlates of repeat lipid testing in patients with CHD who have already attained the guideline-recommended low-density lipoprotein (LDL-C) target of <100 mg/dL and received no further treatment intensification [JAMA Intern Med. 2013;173(15):1439-1444].
Data for the analysis were taken from patients with CHD at 7 Veterans Affairs (VA) medical network centers who visited the clinics’ associated community outpatient centers between October 1, 2008, and September 31, 2009. The investigators performed logistic regression analyses to evaluate facility, provider, and patient characteristics associated with repeat testing. Using VA administrative data, the authors studied facility and provider characteristics. They estimated each patient’s adherence to lipid-lowering medications by calculating the medication possession ratio as the number of days the patient had lipid-lowering medication in the 180 days before the patient’s visit per 180 days. A medication possession ratio of ≥0.8 is a well-described measure of patients’ medication adherence.
Mean age of patients was 72.8 years, with predominantly male patients of white race/ethnicity. There was a high prevalence of hypertension (86.2%) and diabetes mellitus (43.9%). Almost 72% of the study patients were taking statins, although only 24.4% were adherent to their lipid-lowering medication regimen (medication possession ratio, ≥0.8).
A total of 27,947 patients had LDC-L levels >100 mg/dL. Of those patients, 9200 (32.9%) had at least 1 lipid panel performed in the 11 months following the index lipid panel without treatment intensification. The total number of additional lipid panels in these 9200 patients with CHD was 12,686 (mean, 1.38 additional lipid panel per patient). In sensitivity analyses that extended the treatment intensification window from 45 to 60 or 90 days from the index lipid panel, 9046 and 8826 patients, respectively, underwent repeat lipid testing without treatment intensification at 60 and 90 days.
Adjusting for facility-level clustering, patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.10-1.22), hypertension (OR, 1.21; 95% CI, 1.13-1.30), higher illness burden (OR, 1.39; 95% CI, 1.23-1.57), or more frequent primary care visits (OR, 1.32; 95% CI, 1.25-1.39) were more likely to undergo repeat testing. Conversely, patients receiving care at a teaching facility (OR, 0.74; 95% CI, 0.69-0.80), from a physician provider (OR, 0.93; 95% CI, 0.88-0.98), or those with a medication possession ratio of ≥0.8 (OR, 0.75; 95% CI, 0.71-0.80) were less likely to undergo repeat testing. Among the 13,114 patients with CHD who met the optional LDL-C target level of >70 mg/dL, repeat lipid testing was performed in 8177 (62.4%) during 11 follow-up months.
The authors said the study had limitations related to its relatively small sampling of patients and its tiny proportion of women. As well, the study’s data sources did not adequately include recommendations for diet or lifestyle modifications.
