Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tozar

Clinical Mentor

Dr. Michelle Pendleton

Committee Member

Dr. Sharon Lock

Abstract

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and more than 610,000 people die every year from ASCVD related causes such as myocardial infarction (MI) or stroke. High cholesterol is one of the leading modifiable risk factors for prevention of ASCVD events. The 2013 American College of Cardiology/American Heart Association guidelines recommend treatment of high cholesterol as primary prevention for ASCVD in adults by lifestyle changes, CV risk estimation with an ASCVD calculator, and intensity dosing of statin medication. Effective strategies to support these recommendation exist in the clinical practice guidelines but evidence suggest use of the ASCVD calculator for risk estimation and statin intensity dosing in primary care is not being implemented by primary care practitioners (PCP) consistently.

Purpose: The purpose of this study was to evaluate current hyperlipidemia practices in a Norton Medical Associates Clinic (NMA) to establish baseline use of educational material, cardiovascular risk estimate with an ASCVD calculator, and statin prescribing methods. Methods: In this descriptive study utilizing a retrospective chart review, 300 charts from NMA were randomly selected and reviewed for documentation of 1) serum total cholesterol and LDL-c levels, 2) statin medication and dosage prescribed, 3) the intensity of the statin dosage, 4) ASCVD risk factors, and 5) 10 year CV risk estimation. This project evaluated patients between the ages of 21 and 75 with an active diagnosis of high cholesterol and those that met the requirement for statin therapy according to the 2013ACC/AHA guidelines.

Results: According to the results of this review 36% of patients with high cholesterol were not receiving the recommended statin therapy supported by the 2013-guideline grade A or B recommendations. In the three subgroups of patients with dyslipidemia (high risk, moderate risk, diabetes mellitus (DM), 6 out of 7 patients (86%) in the high-risk group (LDL-c>190) were on the correct type and dosage of a high intensity statin medication. In the moderate risk group (LDL-c 70-189) only 65% were receiving statin therapy. The most concerning result from this study is the moderate risk patient category, where 35% were not receiving any statin therapy when they should have been on at least a moderate intensity statin medication and no ASCVD risk estimate was calculated.

Conclusion: Based on the results from this chart review there is room for improvement for PCPs in the treatment and evaluation of hyperlipidemia patients for primary prevention of ASCVD. This paper will discuss evidence based practice recommendations and suggestions for further investigation.

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