Association of health information technology-driven multidisciplinary approaches with low-density lipoprotein cholesterol target achievement in patients with an acute coronary syndrome

Yi-Sheng Chen; Heng Hsu Lin; Hao-Yuan Tsai; Chien-Lin Lee; Yen-Ting Yeh; Yen-Wen Wu

doi:10.1016/j.ajpc.2023.100613

Association of health information technology-driven multidisciplinary approaches with low-density lipoprotein cholesterol target achievement in patients with an acute coronary syndrome

Am J Prev Cardiol. 2023 Nov 21:17:100613. doi: 10.1016/j.ajpc.2023.100613. eCollection 2024 Mar.

Authors

Yi-Sheng Chen¹, Heng Hsu Lin¹, Hao-Yuan Tsai¹, Chien-Lin Lee¹, Yen-Ting Yeh¹, Yen-Wen Wu^{1

2

3

4}

Affiliations

¹ Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
² Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, New Taipei City, Taiwan.
⁴ Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan.

Abstract

Objective: Controlling of low-density lipoprotein cholesterol (LDL-C) in patients with acute coronary syndrome (ACS) remains a challenge. Health information technology (HIT) is increasingly being applied to close quality gaps in chronic illness care. The aim of this study was to perform a qualitative review of the association of implementing HIT on lipid management processes of care and LDL-C goal attainment in patients with ACS.

Method: Eligible patients with a discharge diagnosis of ACS from January 2018 to December 2021 at a tertiary medical center were retrospectively reviewed. An HIT system with a multidisciplinary approach including initiating high-intensity statin therapy, periodic laboratory follow-up, titration of lipid-lowering agents, patient education, patient-level and system-level interventions involving database monitoring and outreach by centralized care teams was introduced in October 2018. Electronical medical records including data on medications and laboratory findings at discharge and within 1 year were compared before and after implementing the HIT system.

Results: A total of 2001 ACS patients (average age 63 ± 12.7 years, 79.66 % men) were analyzed. The LDL-C < 70 mg/dL goal attainment rates (36.52 %, 53.57 %, 59.22 %, 62.18 % in 2018-2021) and medium serum LDL-C levels (80.5 mg/dL, 68 mg/dL, 65 mg/dL, 64 mg/dL in 2018-2021) significantly improved within 6 months (2018 as the reference, all p<0.001). The LDL-C attainment rate at 12 months also steadily increased (53.80 %, 61.82 %, 64.21 % in 2019-2021, p = 0.019). Most of the patients switched to a high-intensity statins regimen at discharge (0.57 %, 63.67 %, 72.41 %, 84.44 %, in 2018-2021, p<0.001 with 2018 as the reference), with low adverse event rates. The maintenance rates of high-intensity statin regimens at 12 months continued to improve (41.36 %, 49.04 %, 61.39 % in 2019-2021, p<0.001).

Conclusions: Efforts to control LDL-C should be increased in ACS patients by initiating and intensifying statin treatment earlier. Our results confirmed that a team-based strategy with HIT improved LDL-C target achievement for most patients with ACS.

Keywords: Acute coronary syndrome; Health information technology; High intensity statin; Lowdensity lipoprotein cholesterol.