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French

ID: <

10670/1.n46ygg

>

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Improve the prescription of hypolipidal treatment in acute coronary syndrome: absence of an automatic alert.

Abstract

introduction: Only 25-30 % of patients with acute coronary syndrome (RCS) achieve the LDL-cholesterol (LDL-C) target values in their follow-up. The purpose of this pre-/post-study is to test a centralised automatic alert to improve practices. The alert appears on laboratory leaves for all patients with troponin > = 0,1 microg/l; in particular, it specifies the recommendations for the lipid profile (target LDL-C) to be achieved. Method: Any patient admitted to CHUV for a RCS with troponin > = 0,1 microg/l was eligible. During the 2 phases of the study (from 23.11.2008 to 15.08.201), a complete lipid balance was determined at admission and at 3 months. Phase 1 (pre) was observational and the alert message was introduced for phase 2 (post). Results: Phase 1: 157 patients of whom 56 (35 %) were already treated with a statin: 114 men (average age 62) and 43 women (73 years). Average LDL-C: 3,4 ± 1,0 mmol/l at admission and 2,4 ± 0,8 mmol/l at 3 months (p < 0,001). Phase 2: 140 patients of whom 42 (30 %) were already treated with a statin: 116 men (62 years) and 24 women (67 years). Average LDL-C: 3,4 ± 1,1 mmol/l at admission and 2,2 ± 1,0 mmol/l at 3 months (p < 0,001). 66 % (104 patients) reach a target LDL-C < = 2,6 mmol/l at 3 months in phase 1, compared to 78 % (110 patients) in phase 2 (p = 0,2). Patients already given statin at admission have a small decrease in LDL-C to 3 months (from 2,8 to 2,5 mmol/l phase 1, p < 0,05; from 2,5 to 2,6 mmol/l phase 2, p = 0.2), while patients in whom a statin is introduced for admission have a significant and greater decrease in LDL-C to 3 months (from 3,8 to 2,3 mmol/l phase 1, p < 0,001; 3,7 to 2,1 mmol/l phase 2, p < 0,001) than patients already given statin beforehand. Conclusion: The observational phase shows a high rate of patients reaching a 3-month target LDL-C. The introduction of a centralised automatic alarm failed to improve these results. On the other hand, patients arriving at hospital with a SCA and already on statin should have an intensification of their treatment.

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