Evaluation of Adherence to current guidelines for treatment of hyperlipidemia in adults in an outpatient setting

Purpose: Adherence to the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guideline at an outpatient clinic was evaluated. Methods: This retrospective chart review study was conducted from December 1, 2013, through November 30, 2014, at an urban outpatient clinic. Estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated based on the pooled cohort equation for all patients. Patients were categorized into one of four statin-benefit groups, in descending order of ASCVD risk. The recommended intensity of a statin and the therapeutic response were determined for each patient. If statin therapy was indicated, patients were assigned to the moderate-intensity, moderate- or high-intensity, or high-intensity group according to guideline recommendations. These guideline-recommended statin intensities were then compared to the patient's prescribed statin to determine guideline concordance. Therapeutic response, expressed as the percent decrease in low-density lipoprotein cholesterol, was determined based on recommended statin intensity. Results: A total of 255 patients were initiated on statin therapy; 193 were included for data analysis. Overall adherence to the guideline was 65.8%, with the highest rate in the group of patients with the lowest risk of ASCVD (97.8%). The group with the lowest rate of adherence to recommendations was patients with clinical ASCVD (46.9%). Only 31.6% of patients had a follow-up lipid panel performed, and even fewer achieved a therapeutic response. Conclusion: A majority of patients were initiated on the appropriate intensity of statin therapy according to the ACC/AHA cholesterol guideline. Of the small number of patients who had follow-up visits, few achieved a therapeutic response based on their prescribed statin therapy.