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Drug utilization

Lipid-lowering treatment in coronary artery disease: a survey in an ambulatory outpatient clinic

S. Harder, O. Mohr and H. Klepzig

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Volume 39 p. 534 - 538

Abstract

S. Harder¹, O. Mohr¹ and H. Klepzig²

¹Institute of Clinical Pharmacology, University Hospital, Frankfurt/Main, and ²Städtische Kliniken Offenbach, Germany
Objectives: In controlled trials, HMG-CoA reductase inhibitors (statins) effectively reduced cardiovascular events in patients with coronary artery disease (CAD). However, recent pharmacoepidemiological studies indicate an underuse of statins in the target population. The objective of this study was to examine the extent to which CAD patients in Germany actually received statins under field conditions. Methods: We evaluated the medical records of 296 patients referred to the cardiology outpatient clinic of the Frankfurt University Hospital by their general practitioner (GP) in the period 1995 to 1998. All patients had symptomatic, angiographically proven CAD, 142 had previous myocardial infarction. A diagnosis of dyslipidemia was taken from the records. Most patients were visited on more than 1 occasion. In all, we were able to access 296 records for a 1st visit, 76 records for a 2nd visit and 29 records for a 3rd visit and 16 records for > 3 visits. Results: According to the entry criteria of the 4S Trial (total cholesterol 5.5 – 8.0 mmol/l or 212 – 311 mg/dl), 108 patients were deemed as eligible for lipid-lowering treatment, criteria of the LIPID Trial (4.0 – 7.0 mmol/l or 154 – 270 mg/dl) gave a yield of 190 patients. The actual treatment rate with a statin at the 1st visit was 34% (LIPID Group) and 40% (4S Group). At later visits, the treatment rates with statins increased to 63% (LIPID Group) and 79% (4S Group), due to advice given to the GP by the outpatient clinic. When the observation period was devided into 2 periods (04/95 – 01/97; 02/97 – 09/98), actual treatment rates (all visits) for the 4S Group were 43% and 38%, respectively, indicating no further “penetration” of the 4S Study in the therapy decision-making of the GPs. Conclusions: The data indicate that necessary treatment with a HMG-CoA reductase inhibitor is often withheld in the ambulatory setting.Correspondence to:
PD Dr. S. Harder; Institute of Clinical Pharmacology at the Pharmazentrum Frankfurt, University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany
Email: [email protected]

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