Evidence map›Paper›PMID 10632815›Full record

ArticleJournal of general internal medicine1999

Undertreatment of hyperlipidemia in the secondary prevention of coronary artery disease.

S R Majumdar, J H Gurwitz, S B Soumerai

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors.

S R MajumdarDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
J H Gurwitz
S B Soumerai

Funding

MEDICARE CAPITATION AND QUALITY OF CARE FOR ACUTE MIR01AG014474 · NIA · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI SOUMERAI, STEPHEN B · 1997 to 1999
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IMPROVING COMPLIANCE WITH ACUTE MI PRACTICE GUIDELINESR18HS007357 · AHRQ · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI SOUMERAI, STEPHEN B · 1992 to 1996
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AHRQ HHS HS07357NIA NIH HHS AG14474
6 · The paper itself

Abstract

objectivesTo determine adherence to national guidelines for the secondary prevention of coronary artery disease (CAD) using lipid-lowering drugs (LLDs), by studying the rate of use of LLDs, predictors of use, and the rate of achieving lipid goals, among eligible patients recently hospitalized with acute myocardial infarction.

designCross-sectional analysis of 2,938 medical records, collected from July 1995 to May 1996.

settingThirty-seven community-based hospitals in Minnesota. PATIENTS: The 622 patients had previously established CAD and hyperlipidemia (total cholesterol> 200 mg/dL or currently using LLDs), and were eligible for LLDs according to the National Cholesterol Education Program II (NCEP II) Guidelines. MEASUREMENTS: The use of LLDs in eligible patients (primary outcome) and successful achievement of NCEP II goals (total cholesterol <160 mg/dL) among treated patients (secondary outcome). MAIN

resultsOnly 230 (37%) of 622 eligible patients received LLDs. In multivariate logistic regression, factors independently related to LLD use included age greater than 74 years (adjusted odds ratio [AOR] 0.55; 95% confidence interval [CI] 0.35, 0.88) and severe comorbidity (AOR 0.60; 95% CI 0.38, 0.95), managed care enrollee (AOR 1.56; 95% CI 1.02, 2.39), past smoker (AOR 1.72; 95% CI 0.98, 3.01), prior revascularization (AOR 2.31; 95% CI 1.51, 3.53), and the use of aspirin (AOR 1.59; 95% CI 1.07, 2.38) or >/=4 medications (AOR 2.89; 95% CI 2.19, 3.84). Of the treated patients who had lipid levels measured (n = 149), 15% achieved the recommended goal of a total cholesterol below 160 mg/dL. Of the untreated patients (n = 392), 89% were discharged from hospital without a LLD prescription.

conclusionsLipid-lowering drugs, although proven effective for the secondary prevention of CAD, were used by only one third of eligible patients. Among patients receiving LLDs, few achieved recommended lipid goals. Directed quality improvement interventions, such as starting LLDs during hospitalization, may have the potential to substantially reduce CAD morbidity and mortality in this vulnerable population.

Indexed as

Drug UtilizationAdultAgedConfidence IntervalsCoronary DiseaseCross-Sectional StudiesFemaleHumansHyperlipidemiasHypolipidemic AgentsLogistic ModelsMaleMiddle AgedMultivariate AnalysisRetrospective StudiesRisk AssessmentHypolipidemic Agents

Identifiers

PMID10632815
PMCPMC1496865

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.