In the 6 years since the National Cholesterol Education Program reduced the LDL (“bad”) cholesterol target from 100 mg/dL to 70 mg/dL in patients deemed at very high risk for a heart attack, experts have consistently raised doubts the aggressive goal could be met in most patients. Several studies confirmed the challenge, showing that that only 15-30% of the very high risk patients achieved the target.
Recently however, Denver-based clinicians affiliated with Kaiser Permanente have reported that 43% of their very high risk patients reached the aggressive target, and they credit their HealthConnect electronic health record and care coordination strategies for the success.
To document the success of their intervention strategies, Amy Kauffman and colleagues of the Clinical Pharmacy Cardiac Risk Service Study Group implemented a retrospective, cross-sectional study of 7,427 patients in the Kaiser Permanente Colorado healthcare system. Subjects were at least 18 years old and, consistent with NCEP guidelines, were characterized as being at very high risk for sustaining a heart attack by virtue of having established coronary artery disease and multiple coronary risk factors like diabetes and high blood pressure.
The patients were voluntarily enrolled in a disease management program in which clinical pharmacy specialists and nurses helped physicians manage medications known to be effective in preventing future heart attacks and provided educational materials regarding healthy lifestyle. Kaiser’s HealthConnect EHR and associated disease registries helped care teams coordinate care for enrolled subjects.
The clinicians helped 3,226 patients (43%) achieve target LDL cholesterol levels of less than 70 mg/dL. Over 90% of these patients required HMG-CoA reductase (statin) therapy, either alone or in combination with another cholesterol-lowering agent. Eighty-seven percent of the patients took a generically-available statin.
“Kaiser Permanente’s integrated care delivery model, supported by electronic medical records and health information technology, has great benefits for patients with heart disease over the long term,” coauthor Kari Olson told HealthcareITnews.
“We believe our patients achieved their cholesterol goals at higher rates because of our proactive team approach, close monitoring and follow-up, and the computer systems we have in place.”
A previous study by the same clinicians showed the HealthConnect EHR helped Kaiser providers keep heart patients healthy years after discharge for non-fatal coronary events.
The study appears in the Journal of Clinical Lipidology.
Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs, Practice Fusion
