Use of Lipid-Lowering Drugs With Acute Myocardial Infarction Patients: An Examination of Physician Prescribing Behaviors

Abstract

Background : Clinical trials have shown that the use of lipid-lowering agents in postmyocar dial infarction (MI) patients reduces rates of subsequent coronary events, reduces coronary artery bypass surgery rates, and improves survival. Physician decisions to prescribe lipid- lowering drugs is influenced by a number of patient factors, including age, medical history, and serum cholesterol levels. The purpose of this study was to examine physician behaviors in prescribing lipid-lowering therapy in patients after acute MI.

Methods and Results: A retrospective study was conducted at a local community-based hospital. A total of 129 patients with validated acute MI, hospitalized between January 1996 and December 1996, was included in the study sample. Variables abstracted included patient age, sex, race, primary diagnosis, medical history, lipid-lowering interventions of the discharge plan, and other discharge instructions regarding smoking cessation, activity, and dietary modification. Descriptive analysis was performed. The study showed that only 7 sub jects (8.8%) were discharged on lipid-lowcring drugs. Several patients who did not undergo therapy had either a low-density lipoprotein concentration of < 130 (n = 13), a high-density lipoprotcin concentration of >50 (n = 6), or were on hormone replacement therapy (n = 3). Dietary modification was advised in 100% of subjects (n = 54) for whom the data were included in the charts.

Conclusions: The results of this descriptive study suggests that lipid-lowering drugs are being utilized at low rates in the secondary prevention of acute MI. However, additional risk-lowering factors may play a role in the decision to discharge without drugs. Because of potential side effects associated with their use, a prudent path appears to be the norm in prescription of lipid-lowering drug therapy for MI patients.