The following is a summary of “Rarely tested or treated but highly prevalent: Hypercholesterolemia in ED observation unit patients with chest pain,” published in the September 2023 issue of Emergency Medicine by Ashburn, et al.
Hypercholesterolemia (HCL) is common among Emergency Department (ED) patients with chest pain but is typically not addressed in this setting. For a study, researchers sought to determine whether a missed opportunity for Emergency Department Observation Unit (EDOU) HCL testing and treatment exists.
In the retrospective observational cohort study, researchers evaluated patients ≥18 years old who were assessed for chest pain in an EDOU between 3/1/2019 and 2/28/2020. Patient demographics and HCL testing and treatment occurrences were obtained from electronic health records. HCL was identified through patient self-report or clinician diagnosis. The study calculated the proportions of patients who received HCL testing or treatment at 1 year following their ED visit. Additionally, it compared HCL testing and treatment rates at 1 year among white vs. non-white and male vs. female patients using multivariable logistic regression models, considering age, sex, and race.
Of 649 EDOU patients with chest pain, 55.8% (362/649) had known HCL. Among those without known HCL, 5.9% (17/287, 95% CI 3.5–9.3%) had a lipid panel during their index ED/EDOU visit, and 26.5% (76/287, 95% CI 21.5–32.0%) had a lipid panel within 1-year of their initial ED/EDOU visit. For patients with known or newly diagnosed HCL, 54.0% (229/424, 95% CI 49.1–58.8%) were on treatment within 1-year. After adjusting for various factors, testing rates were similar among white vs. non-white patients (aOR 0.71, 95% CI 0.37–1.38) and men vs. women (aOR 1.32, 95% CI 0.69–2.57). Treatment rates were also similar among white vs. non-white (aOR 0.74, 95% CI 0.53–1.03) and male vs. female (aOR 1.08, 95% CI 0.77–1.51) patients.
The study highlighted a missed opportunity in addressing hypercholesterolemia in the Emergency Department or EDOU, as few patients received evaluation or treatment for this condition. The oversight could potentially increase the risk of cardiovascular disease in these patients.