For patients with coronary heart disease (CHD), current performance measures recommend annual lipid testing, followed by treatment intensification in cases when abnormal lipid levels are spotted. Little is known, however, about the frequency and correlates of repeat lipid testing in patients with CHD who have already attained guideline–recommended LDL-cholesterol (LDL-C) treatment targets and receive no treatment intensification. “In these patients, repeat lipid testing may represent health resource overuse and possible waste of healthcare resources,” says Salim S. Virani, MD, PhD.
Intriguing New Findings on Repeat Lipid Testing
In JAMA Internal Medicine, Dr. Virani and colleagues had an analysis published that sought to determine the frequency and correlates of repeat lipid testing in patients with CHD who have already attained the guideline-recommended LDL-C target of less than 100 mg/dL and received no further treatment intensification. Among 27,947 patients with LDL-C less than 100 mg/dL, the data showed that 9,200 patients (32.9%) had another repeat lipid panel performed at 11 months from their first lipid panel in the absence of any treatment intensification.
“Overall, about one-third of patients with CHD continued to undergo lipid testing after they achieved their LDL-C goal without treatment intensification,” says Dr. Virani. “More than 9,000 patients had additional lipid panels in the 11 months after they achieved an LDL-C target of less than 100 mg/dL in the absence of any further treatment intensification (which could be performed to attain the optional treatment target of LDL-C less than 70 mg/dL). About two-thirds of patients in our analysis who also met the optional LDL-C treatment target of less than 70 mg/dL had repeat lipid testing within 11 months from their initial lipid panel.”
In regression analyses, repeat lipid testing was associated with the following:
Odds Ratio (95% CI)
|More frequent primary care visits||
|Greater illness burden of a patient (diagnostic cost group relative risk score >2.00)||
Factors associated with a lower likelihood of repeat testing were care at a teaching facility, care from a physician provider, and adherence to lipid-lowering medications.
Assessing Implications in Patients with CHD
According to Dr. Virani, results of his study team’s analysis have implications for quality assessment, particularly if an impending update of cholesterol guidelines changes the focus of treatment strategies. “These low-cost but high-volume tests and procedures need to be considered if significant savings from reduction of healthcare overuse and/or waste are to be realized,” he says. “Our results highlight areas to target for future quality improvement initiatives aimed at reducing redundant lipid testing in patients with CHD. These efforts would be more relevant if the forthcoming cholesterol guidelines adopt a medication dose-based approach in place of the current treat-to-target approach.”
Readings & Resources (click to view)
Virani SS, Woodard LD, Wang D, et al. Correlates of repeat lipid testing in patients with coronary heart disease. JAMA Intern Med. 2013 Jul 1 [Epub ahead of print]. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1705724.
Virani SS,Woodard LD, Landrum CR, et al. Institutional, provider, and patient correlates of low-density lipoprotein and non–high-density lipoprotein cholesterol goal attainment according to the Adult Treatment Panel III guidelines. Am Heart J. 2011;161:1140-1146.
Virani SS,Wang D,Woodard LD, et al. Non–high-density lipoprotein cholesterol reporting and goal attainment in primary care. J Clin Lipidol. 2012;6:545-552.
Hayward RA, Krumholz HM. Three reasons to abandon low-density lipoprotein targets: an open letter to the Adult Treatment Panel IV of the National Institutes of Health. Circ Cardiovasc Qual Outcomes. 2012;5:2-5.
Glasziou PP, Irwig L, Heritier S, Simes RJ, Tonkin A; LIPID Study Investigators. Monitoring cholesterol levels: measurement error or true change? Ann Intern Med. 2008;148:656-661.
Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National